Despite being a leading cause of severe liver disease across the world, alcohol-related liver disease (ALD) is often diagnosed at the decompensation stage. Liver biopsy continues to be the gold standard for diagnosing and assessing the fibrosis stage of ALD; however, this is an invasive procedure and is associated with significant morbidity.

Over the last 10 years or so, non-invasive tests have been put to practice for evaluating the severity of liver fibrosis and steatosis. Measurement of liver stiffness by transient elastography is the most frequently used non-invasive parameter for the assessment of fibrosis. In ALD, transient elastography seems to have an excellent performance when it comes to detection of advanced fibrosis and cirrhosis.

Aspartate aminotransferase levels must be considered when interpreting liver stiffness cut-offs. Non-invasive biological tests have also been studied to assess liver fibrosis in ALD. While ultrasound is still an initial screen for fatty liver diagnosis, new methods have been introduced to detect steatosis. Magnetic resonance spectroscopy and magnetic resonance imaging have high degree of accuracy and reproducibility, with superior sensitivities and specificities for the detection of histological steatosis when compared with ultrasound. However, low availability and high cost tend to restrict the use of magnetic resonance techniques in routine clinical practice.

Lately, controlled attenuation parameter was developed as a novel tool to aid in the non-invasive assessment of liver steatosis. When performed in conjunction with transient elastography, it was reported to be superior to regular ultrasound for steatosis detection and had acceptable diagnostic accuracy.

Source: Moreno C, Mueller S, Szabo G. Non-invasive diagnosis and biomarkers in alcohol-related liver disease. Journal of Hepatology 2019;70(2):273-83.