This is an area of much interest for those involved with non-alcoholic liver health. The same blood tests used in the diagnosis of NAFLD are also used for NASH. Historically, the liver biopsy has been proclaimed as the “Gold Standard” of NASH diagnosis. There a number of disadvantages to a biopsy including cost, risk of infection and potential errors as the liver sample may not be representative of the entire liver (e.g., disease may not be present in the entire organ). Despite these disadvantages, a liver biopsy is required in clinical trials for the development as NASH drugs per the dictates of the FDA.
There are many developments in the area of non-invasive tests. Among the tests currently used are MRIs and similar tests and the FibroScan (used to measure liver stiffness).The fibroscan is becoming increasingly popular with hepatologists.
Often, doctors will use “all of the above” to make their diagnosis.