The Role Of Non-Invasive Methods In Evaluating Liver Fibrosis Of Patients With Non-Alcoholic Steatohepatitis

Objectives: Liver biopsy is the gold standard for diagnosing the extent of fibrosis in NAFLD/NASH; however, it is invasive with the risk of serious complications. This study aimed to validate the diagnostic usefulness of FIB4, NAFLD Fibrosis Score (NFS), FibroScan and ARFI in assessing liver ?brosis in patients with NAFLD/NASH. Patients and Methods: The study was carried out on 101 patients with NASH. All patients underwent a liver biopsy for histological assessment of liver fibrosis and non-invasive methods for assessment of liver fibrosis including FIB4, NFS, FibroScan, and ARFI. Cut-off values along with the diagnostic accuracy of these methods were determined by receiver-operating characteristic (ROC) curves.  Results: Histological liver fibrosis was evaluated by Metavir scoring (F0: 10 cases; F1: 47 cases; F2: 24 cases; F3: 17 cases; and F4: 3 cases). Liver stiffness determined by FIB4, NFS, FibroScan, and ARFI were significantly correlated with the fibrosis stages (Spearman rho: 0.32; 0.51; 0.56 and 0.54; p<0.05, respectively). AUROC of FIB4, NFS, FibroScan and ARFI for diagnosing ≥ F3 were 0.6, 0.8, 0.8, and 0.9, respectively. FibroScan, ARFI v/s NFS were more accurate than FIB4 for diagnosing ≥ F3 (p<0.05). Among those, NFS had the highest sensitivity for diagnoses of ≥ F3. The specificity values of NFS, ARFI and TE were greater than 80% for diagnosing ≥ F3. Conclusions: Liver stiffness determined by these methods had significantly correlated with the fibrosis stages. FibroScan and ARFI had more accurate than NFS and FIB4 in diagnosis of advanced fibrosis. NFS was the best method for screening advanced fibrosis (≥ F3) in patients with NASH.