Diagnosis of MASLD
Since both MASLD and MASH do not show any symptoms they are very often incidentally diagnosed during routine blood tests with elevated liver enzymes or ultrasound scanning done for reasons other than fatty liver. Doctors diagnose both MASLD and MASH by using various diagnostic tools.
Initially your doctor will evaluate you if you have any risk factors of MASLD and rule out any other potential causes.
Screening for Risk Factors: A thorough medical history will be taken, including questions related to your health conditions that are considered risk factors for developing MASLD.
Most importantly, the doctor will ask about your alcohol intake to rule out alcoholic liver disease.
Physical examination: During a physical examination, your doctor examines your body to look for signs such as
Rules out other potential causes of fatty liver: Your doctor will exclude other diagnosed potential causes of fatty liver like
Along with ALT and AST certain other substances and tests also give an idea about liver damage. Biomarker tests are one such type of blood tests that help in identifying certain substances in blood that reflect the presence of particular disease. But it should be remembered that these tests alone may not establish the presence of MASLD or MASH.
Some of the serum biomarker tests
While diagnosing MASLD your doctor will recommend further blood tests that help in ruling out other causes of fatty liver disease (with elevated liver enzymes) like viral hepatitis, autoimmune liver disease, and metabolic or inherited liver disease.
Imaging studies are those studies where the images of the internal organs can be produced giving us a picture of what is inside the body. Imaging studies that are commonly used in the diagnosis of MASLD are
A person will be diagnosed with MASLD only if there is fat accumulation in liver in imaging studies (ultrasound and CT) with no significant consumption of alcohol, no other competing reasons for fatty Liver and no other co –existing liver diseases.
The imaging studies establish the accumulation of fat in the liver but cannot differentiate the type of fatty liver, like whether it’s just a simple fatty liver or more serious form like MASH or determine the degree of fibrosis in the liver.
To know the whether the degree of fibrosis is advanced, bridging fibrosis (stage 3) or cirrhosis (stage 4) your doctor will use the following methods.
To evaluate the degree of fibrosis or amount of liver tissue that is damaged and replaced with fibrous tissue your doctor will use certain clinical decision tools like FIB-4 index, NFS score that combine the results of your blood tests, with your risk factors for MASLD.
The liver becomes stiff due to fibrosis or scar tissue and fat accumulation, normal ultrasound scans can not measure this, but special scans can measure the liver stiffness to ascertain the degree of fibrosis and fat level. Special scans
MASH cannot be diagnosed by blood tests and imaging studies. At present, the only reliable way of diagnosing whether a person with fatty liver has MASH is by a liver biopsy.
Is a procedure where a very small piece of liver is retrieved through a needle and tested under microscope for its contents.
Liver Biopsy is considered only in MASLD patients with
MASH can be diagnosed only by a biopsy and only if the tested piece of liver shows infiltration of the liver with fat along with inflammation and different degrees of scarring.
Your doctor may recommend you for blood tests (liver function tests), and other tests if you have risk factors for MASLD/MASH and will proceed further depending on the test results.
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