Noninvasive Tests for Hepatic Fibrosis (NITs)

For screening high risk-populations Fib-1 is the First-line of Defense. Sequential or combination testing can be done to address the Grey Zone.

For identification of at-risk NASH, use the FibroScan-AST (FAST), MRI-aspartate aminotransferase (MAST), MR elastography combined with FIB-4 (MEFIB) or Agile 3t (F3 fibrosis).

To assess response to Resmetirom - check for a 30% reduction in MRI proton density fat fraction (MRI-PDFF), Pro-C3/C3M ratio and vibration-controlled transient elastography (VCTE). For evaluating progression to cirrhosis check for VCTE >16.6 kPa, ELF >9.75.

For predicting MALO check if ELF >11.27, VCTE >30.7 kPa, cT1 >875 ms, MAST >0.24, ME-FIB + (MRE ≥3.3 and FIB-4 ≥1.6). Longitudinal changes over time are more important than a single cross-sectional view. Use FIB-4, VCTE and MR elastography