A PATIENT’S GUIDE TO NON-INVASIVE TESTS (NIT)

The diagnosis and monitoring of liver disease can be confusing to patients. While most of us have heard of liver biopsies, not everyone knows about the variety of NITs that are currently in use.

While long considered the gold standard for diagnosing liver disease, invasive liver biopsy is an unpleasant procedures that carries its own set of risks. In addition, there are studies that indicate that a biopsy may be no more accurate than non-invasive tests. Our experience is that no one wants a liver biopsy. Here are some reasons why you might not want to have one:

• A liver biopsy only looks at a tiny sliver of the liver; liver disease is not necessarily uniform throughout the liver so it may not actually depict overall liver health
• May be useful for an initial diagnosis, but generally unsuitable for monitoring a condition over time
• It can be painful
• There is a risk of infection
• Bleeding can result
• The process is time consuming and requires someone to accompany the patient
• There is variation in results interpretation

So why is it the gold standard? Well for one, the FDA requires a biopsy to measure endpoints in clinical trials. Hopefully, that will change over time as the evidence mounts regarding the usefulness and accuracy of NITs. Also, it is the only test that directly analyzes tissue samples. That does provide histological advantages

The purpose of this page is to provide an overall understanding from the patient perspective of the NITs that are presently in use and the circumstances in which they are presently used. This will facilitate informed discussions with your physician regarding the alternatives available for detecting and monitoring potential liver disease.

NITs have a large and growing role in the detection, staging and monitoring of liver disease. Their use is advised if you have any of the risk factors (diabetes, obesity, high blood pressure, etc.) associated with Nonalcoholic Fatty Liver Disease (NAFLD) or Nonalcoholic Steatohepatitis (NASH). The goal is to detect the presence of this disease and monitor its progression. Most people will not see their disease progress to a serious stage but any one at risk should monitor their liver health.

NITs fall into two general categories : 1) blood or serum testing or 2) imaging technologies. Generally, the blood tests is done initially for patients having any of the risk factors or experiencing symptoms. Our experience is that these tests are not done in the normal course of business and you may have to request them from your doctor. If this testing indicates a concern, the next step is to proceed to imaging. This usually begins with a referral to a specialist and the performance of an ultrasound. If problems are indicated the progression would then be to more sophisticated imaging technologies where the appearance and characteristics of the liver can be viewed by technicians and doctors.

The following tables provide general guidance on the use of the various forms of non-invasive testing. The first table describes serum, or blood, test. The second describes imaging tests.

Serum Tests

Imaging Tests