Non-Invasive Liver Diagnostic Techniques
- To choose the best course of treatment and forecast clinical results, it is essential to know whether and how severe hepatic fibrosis is. The accepted practice of using liver biopsy to evaluate hepatic fibrosis is currently under threat due to growing understanding of the associated risks (invasiveness, sample inaccuracy, inter- and intra-observer variability).
- Simultaneously, non-invasive methods for assessing liver fibrosis have grown rapidly in recent years, and a wide range of non-invasive approaches, including imaging techniques and serum testing, have been developed. Certain techniques, including transient elastography in Europe and the Fibrotest/Fibrosure, have been validated and are becoming more and more used in ordinary clinical practice, particularly in the treatment of chronic hepatitis C.
Overview of Non-Invasive Liver Diagnostic Techniques
- Over time, fibrosis can result from any liver etiology that causes inflammation in the liver, such as alcoholism, fatty liver, hepatitis B and C, autoimmune and metabolic liver diseases, etc. Liver biopsy is not the most convenient or suitable test in most general practice settings, despite being essential in establishing the stage of liver fibrosis in chronic liver disease. This is a result of liver biopsy’s high resource requirements, invasive nature, and sample error risk.
- On the other hand, non-invasive tests (NITs) for liver fibrosis are more accessible at the best liver transplant hospital in Mumbai, India and are useful for a variety of liver diseases. In general practice, NITs can be a helpful tool for classifying high-risk patients who might need to be sent to a specialist for care or for additional tests.
Importance of Early Detection and Diagnostic tests for liver health diseases
If left untreated, liver disease is a dangerous medical condition with potentially dire effects. For liver illnesses to be effectively managed and complications to be avoided, early diagnosis and timely treatment are essential with the assistance of the best liver treatment doctors in Mumbai, India.
Why Timely Diagnosis Is Critical?
- Maintaining Liver Function: Early detection of liver illness can help stop additional harm and maintain the liver’s essential activities.
- Avoiding Complications: Prompt management can stop liver disease from progressing to more severe stages, which lowers the chance of consequences like liver failure and cirrhosis.
- Greater Treatment alternatives: Having more alternatives for treatment in the early stages increases the likelihood of success.
Blood Tests for Liver Function Assessment
Tests for liver function can be used to:
- Check for hepatitis and other liver illnesses.
- Keep an eye on a condition, such alcohol or viral hepatitis, and assess how well a treatment is doing.
- Keep an eye out for warning indications of serious illness, including cirrhosis, or liver scarring.
- Keep an eye out for any possible drug side effects.
Assessments for liver function measure the amounts of specific proteins and enzymes in your blood. Elevations or decreases from normal can indicate abnormalities with the liver. The overall clinical picture, in conjunction with the pattern and degree of elevation of these tests, can offer clues on the underlying source of these issues.
Liver Enzyme Tests: ALT, AST, ALP
Liver enzyme tests, such as ALT (Alanine Aminotransferase), AST (Aspartate Aminotransferase), and ALP (Alkaline Phosphatase), are essential diagnostic tools to assess liver health. ALT and AST are enzymes found in liver cells, and their elevated levels in the bloodstream can indicate liver damage or inflammation. ALT is more specific to the liver, while AST is also found in other tissues like the heart and muscles. ALP, on the other hand, is involved in bile flow, and high levels may suggest issues with bile ducts or liver disorders. Together, these tests provide a comprehensive view of liver function and help in diagnosing conditions like hepatitis, cirrhosis, or bile duct obstructions. Early detection through these enzyme tests enables timely treatment and better management of liver-related diseases.
Alanine transaminase (ALT)
The liver contains an enzyme called ALT, which aids in the conversion of proteins into energy for the liver cells. ALT levels rise in response to liver injury because it is secreted into the bloodstream. The SGPT is another name for this exam.
Aspartate transaminase (AST)
An enzyme called AST aids in the body’s breakdown of amino acids. Similar to ALT, AST is often found in blood at low concentrations. Elevated AST values could indicate liver illness, injury to the liver, or harm to the muscles. SGOT is another name for this exam.
Alkaline phosphatase (ALP)
An enzyme called ALP is essential for breaking down proteins and is present in the liver and bone. Since this enzyme is also found in bones, elevated levels of ALP may indicate diseases of the liver, such as a blocked bile duct, or certain disorders of the bones.
Bilirubin Levels: Indicators of Liver Health
- A consequence of the breakdown of aged red blood cells is bilirubin. Red blood cells decompose after completing their life cycles in the body and go via the circulation to the liver where they are processed. Bilirubin and other waste products are sorted by your liver into a fluid known as bile. Your intestines are where bile leaves your body. The pigment that gives bile its characteristic yellow hue is called bilirubin. It tints your excrement as well.
- The amount of bilirubin in your blood is determined via a bilirubin blood test. A tiny sample of your blood is taken from a vein by a medical professional, who then sends it to a lab for analysis. Your bilirubin levels will be measured in the lab to see if they fall within the usual range. Elevations or decreases in bilirubin levels may suggest a malfunction in the breakdown and elimination of old red blood cells.
Serum Albumin and Total Protein Tests
The total amount of protein in your blood is determined by an albumin/globulin (A/G) ratio test and total protein. The blood contains two main forms of protein:
Albumin
Which aids in preventing blood clots from forming in blood arteries. In addition, it facilitates the body’s circulation of vitamins, hormones, medications, and other essential materials. The liver is where albumin is created.
Globulins
- They transport nutrients throughout the body and aid in the fight against infection. The liver produces a few different globulins. The immune system produces others.
Additionally, the test contrasts the levels of globulin and albumin in your blood. The A/G ratio, or albumin/globulin ratio, is the name of the comparison.
Imaging Techniques for Liver Evaluation
One of the body’s most important organs, the liver carries out crucial processes such protein synthesis, detoxification, and metabolism. For this reason, early detection and diagnosis of liver illnesses are essential for proper management and treatment. Modern medical imaging methods are essential for liver disease detection, diagnosis, and follow-up.
Ultrasound: Assessing Liver Size and Texture
An essential tool for evaluating liver health and identifying a range of hepatic disorders is liver ultrasonography. By providing useful information on the size, shape, and texture of the liver, this imaging method aids in the detection of any potential abnormalities or diseases. Several techniques for doing ultrasound exams can be used to evaluate the liver efficiently:
Abdominal Ultrasound
The most popular technique for assessing the liver is an abdominal ultrasound. After applying a transducer to the patient’s belly, pictures of the liver and other organs are captured. With the use of this technology, the structure of the liver can be thoroughly examined in order to identify any liver tumours, cysts, or fatty liver disease.
Doppler Ultrasound
It is utilized to evaluate hepatic vascular flow and hepatic blood flow. This method aids in the diagnosis of diseases such hepatic artery stenosis, liver cirrhosis, and portal hypertension.
Magnetic Resonance Imaging (MRI): Detailed Imaging of Liver Structure
- A liver MRI can reveal abnormal growths as well as the liver’s structure. Additionally, liver treatment doctor will be able to observe blood flow within the liver, which might reveal important details regarding vascular conditions that may impact this organ.
- You can choose to use or not use contrast dye during a liver MRI. An image scanned with contrast dye usually comes out sharper and brighter than one scanned without it.
- A liver MRI provides a very detailed image that allows specialists to diagnose a variety of liver disorders with high accuracy.
- For instance, in two different studies from 2018 and 2019, in more than 75% of the patients who underwent these scans, MRIs helped doctors correctly diagnose fatty liver disorders and liver cancer.
- When it comes to identifying benign (noncancerous) and malignant (cancerous) liver lesions, an MRI scan is seen to be the best option.
Computed Tomography (CT) Scan: Identifying Liver Abnormalities
- When other forms of examination, like X-rays, physical examinations, and ultrasounds, are inconclusive, a CT scan of the liver and biliary tract may be carried out to evaluate the liver and/or gallbladder and their related structures for tumours and other lesions, injuries, bleeding, infections, abscesses, unexplained abdominal pain, obstructions, or other conditions.
- To differentiate between obstructive and nonobstructive jaundice, a liver CT scan may be performed. Guidance for biopsies and/or suction of liver or gallbladder tissue is another use for CT images of the biliary tract and liver.
Transient Elastography (FibroScan) for Liver Fibrosis Assessment
Hepatic fibrosis (scarring) is detected by hepatic elastography. It could take the place of a liver biopsy, which entails taking a sample of liver tissue for analysis.
The results of an elastography test can be useful in:
- Identify liver disorders among those at increased risk of developing liver disease.
- Illustrate the gravity of liver illness and offer guidance on liver disease treatment options.
- Track the effectiveness of liver disease treatment and assist in estimating the likelihood that certain severe issues will arise from liver disease.
- Determine the amount of fat in the liver.
A liver fibrosis (scarring) test called an elastography may be necessary if you:
- You have liver disease, and your liver treatment doctor in Mumbai, India needs information to decide on the best course of therapy.
- Have further liver testing revealed that you might have liver damage or inflammation?
- Are at a higher risk of developing severe liver scarring, or cirrhosis. Cirrhosis is more common in the following conditions:
- Alcohol use disorder (AUD)
- Diabetes type 2
- Chronic: enduring Hepatitis B or C
- Some autoimmune conditions or hereditary illnesses
- prolonged usage of some medications
- Possess cirrhosis-related signs and symptoms.
Biomarkers for Liver Disease Detection
Liver function tests (LFTs) are one of the main tools used in clinical practice to diagnose liver disorders. The LFTs are blood tests that are performed as routine examinations to evaluate a person’s general health, to monitor the liver’s function, or to look into suspected liver diseases2. The LFTs are made up of a group of biochemical indicators that are connected to the liver’s different metabolic processes and functions. When a disease or external injury causes liver dysfunction, the levels of these biochemical indicators change. Anomalies identified on liver function tests (LFTs) at the best liver hospital in Mumbai, India can aid in the diagnosis of illnesses affecting the liver as well as other organ systems.
FibroTest: Assessing Liver Fibrosis and Steatosis
- This exam uses a test algorithm that BioPredictive patented. The five common biomarkers included in FibroTest are haptoglobin, alpha-2-macroglobulin, total bilirubin, apolipoprotein A1, and gamma-glutamyltransferase. A marker for inflammatory activity (alanine aminotransferase, or ALT) is added by the ActiTest. The patient’s age and gender determine how these markers are weighted.
- FibroTest-ActiTest measures the degree of necroinflammatory activity in addition to liver fibrosis and cirrhosis. Six common serum indicators (gamma-glutamyl transferase, total bilirubin, alpha-2-macroglobulin, apolipoprotein A1, haptoglobin, and alanine aminotransferase) are measured in order to estimate the amount. An indicator of disease-induced liver inflammation is the activity score. In order to evaluate the patient’s inflammatory activity and hepatic fibrosis scores, the results of these tests are coupled with their age and gender.
ELF Test: Evaluating Liver Fibrosis Progression
- The ELF Test is a non-invasive blood test recommended by the best liver transplant hospital in Mumbai, India that assesses tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), procollagen III amino-terminal peptide (PIIINP), and hyaluronic acid (HA) as three direct markers of fibrosis. In individuals with chronic liver disease, the ELF Test can be used to evaluate the risk of progression to cirrhosis and LREs in addition to other laboratory and clinical findings.
- When used in conjunction with other laboratory results and clinical evaluations, it is recommended as a prognostic marker for patients with advanced fibrosis (F3 or F4) caused by non-hepatitis (NASH) to determine the risk of developing cirrhosis and liver-related clinical events.1. ELFTM can be used repeatedly for the same patient over time because it takes a blood sample instead of a biopsy.
APRI Score: Predicting Liver Fibrosis Severity
Aspartate aminotransferase to platelet ratio index is abbreviated as APRI. When you have a liver ailment, it’s a means for the doctors to gauge how healthy your liver is.
- Your body’s levels of platelets and aspartate aminotransferase (AST) determine your APRI score. Your liver produces an enzyme called AST. One kind of blood cell that aids in wound healing and halting severe bleeding is the platelet.
- Using a blood test, your doctor can determine your platelet and AST levels. It will indicate if your findings are high, low, or normal.
- AST-Your blood typically contains low amounts of AST. However, a diseased liver produces higher amounts of the enzyme due to its release. Cirrhosis is typically indicated by elevated AST levels in the blood.
- Platelets-150,000 to 400,000 platelets per microliter (mcL) of blood is the optimal range. Any platelet count over 400,000 is regarded as high by doctors. This increases your risk of blood clots since your body is producing too many platelets. Anything under 150,000 is considered low, but values below 50,000 indicate a higher chance of severe bleeding. Individuals with cirrhosis frequently have decreased platelet counts.
Role of Non-Invasive Liver assessment Techniques in Liver Disease Monitoring
In individuals with chronic liver disease, non-invasive methods of monitoring hepatic fibrosis are being studied by the best liver expert doctors in Mumbai, India, as liver biopsy substitutes. Non-invasive monitoring options consist of: (1) multianalyte serum assays using algorithmic analysis of direct or indirect biomarkers; and (2) specialized radiologic techniques such as real-time transient elastography (RTE), acoustic radiation force impulse imaging (ARFI), transient elastography, and magnetic resonance elastography (MRE).
Tracking Disease Progression and Treatment Response
- The predictive potential of non-invasive blood indicators for liver-related outcomes has been investigated. The course of liver disease and the response to treatment could be tracked through the serial detection of certain biomarkers. Using FibroTest and APRI to track fibrosis, prothrombin time to monitor cirrhosis, and α-fetoprotein to track liver cancer are a few examples. Vibration-controlled transient elastography with a 20% increase (≥16.6 kPa) indicates cirrhosis development, while ≥30.7 kPa indicates decompensation. A 15% increase in MRE is linked to the advancement of fibrosis, and a 19% increase in MRE is linked to unfavourable results.
- Measuring the viral load, liver enzymes, and FibroTest or FIB-4 at various intervals can assist determine how well antiviral medication is working in cases of viral hepatitis. It’s also critical to keep in mind that some biomarkers could not change much in response to treatment, or they might take longer to improve.
- Non-invasive biomarkers may potentially prove to be beneficial in non-alcoholic steatohepatitis (NASH) medication studies. These instruments may be useful for tracking the development and improvement of liver fibrosis. Nonetheless, it’s critical to recognize their limitations and potential biases and to utilize them in concert with other diagnostic techniques. A higher baseline, larger shift in ELF (>9.76) is linked to a higher chance of developing cirrhosis later on. Liver-related clinical events are predicted by an ELF greater than 11.3.
Reducing the Need for Invasive Procedures
Benefits of Non-Invasive Procedures:-
Comfortable and Painless
One of the main benefits of non-invasive medical devices is that they do away with the necessity for uncomfortable treatments like liver biopsies. Now that patients may undergo liver exams in a relaxed and pain-free manner, more patients will be encouraged to have frequent checkups.
Reduction of Risk
Complications from invasive operations, like bleeding or infection, are always possible. Patients can feel secure having their liver health evaluated thanks to non-invasive technology that successfully remove these hazards.
Quicker Results
The analysis of conventional liver samples can take several days, delaying the choice of appropriate course of treatment. Because non-invasive equipment produce findings quickly, doctors may quickly create treatment programs that are suited for their patients.
Progress Tracking and Repeatability
The best liver hospital in Mumbai, India, regularly monitors liver health using these instruments. This function is particularly helpful for monitoring the course of liver illnesses and the efficacy of various treatments.
Enhancing Patient Comfort and Safety
- An accurate and safe imaging test is ultrasound. Ultrasound imaging doesn’t use radiation, which at large levels can be harmful to health. This is in contrast to X-ray imaging. There are known negative effects from ultrasound.If you require an abdominal ultrasound, you probably want to know what to anticipate on test day. Imaging using ultrasound is non-invasive and safe. It only takes a half hour or so in most circumstances to get the results.
- Fibroscan, also known as ultrasound-based transient elastography, is a specialized type of ultrasound that provides a non-invasive, safe, and accessible procedure option for assessing the liver’s “stiffness.”Fibroscan is a non-invasive test that may be done without sedation at the point of treatment, is painless, and doesn’t require any special preparation. In addition, the test is much less expensive than a liver biopsy, can be completed in just 5–7 minutes, and has not been linked to any negative effects.
Considerations and Limitations of Non-Invasive Liver Diagnostic Methods
These non-invasive methods utilized by the best liver treatment doctors in Mumbai, India, mostly use biological evaluations (such as serum biomarker algorithms) or physical evaluations (such as imaging-based tissue stiffness assessment). The creation of a future generation of fibrosis biomarkers may be hampered by the sampling error built into the reference standard, but the existing NITs have a number of drawbacks, including variability, poor precision, and error risk factors.
Accuracy and Reliability of Results
- Its accuracy is highest when it comes to ruling out or verifying cirrhosis, while it is lowest when it comes to intermediate fibrosis scores. In Europe, the same test is called something else entirely—the FibroTest-ActiTest. Convenience is FibroSure’s main benefit. Cost, the possibility of being influenced by other disorders, and the inability to distinguish between the intermediate phases of fibrosis are the drawbacks. FibroSure should only be utilized in individuals who are actively infected with HCV; patients who have already been cured of HCV infection or who do not have an HCV infection should not use the test.
- The various stages of fibrosis are not covered by the APRI. The APRI has a 77% sensitivity and a 75% specificity for cirrhosis when a cut off of >1.0 is applied. The APRI has a 48% sensitivity and a 94% specificity when a cutoff of >2.0 is applied. APRI’s low cost and convenience stem from the fact that it employs standard laboratory testing. The drawback is that when the score is below the cirrhosis cut-off, it is unable to identify the precise stage of fibrosis.
Cost and Accessibility
Cost and accessibility play a crucial role in determining the reach and impact of products or services. Affordable pricing makes offerings more appealing to a broader audience, especially in competitive markets. Accessibility, both in terms of physical availability and ease of use, ensures that consumers from diverse backgrounds can benefit from the product. When companies strike the right balance between cost and accessibility, they foster customer loyalty and widen their market base. Additionally, technology has helped bridge accessibility gaps, bringing essential services to previously underserved areas. Ultimately, aligning cost with accessibility creates a sustainable growth strategy for businesses.
Serum biomarkers
Patented marker panels are expensive and difficult to get.
Transient elastography
Not frequently paid for, Issues with access in resource-constrained procedures
Shear wave elastography
Outside of specialized centres at best liver transplant hospital in Mumbai, India, not widely accessible
MRE
Expensive Not accessible outside of specialized radiology facilities
Complementary Use with Invasive Procedures
- The most utilized panels liver expert doctors in Mumbai, India at the moment are as follows: aminotransferase-to-platelet ratio index (APRI), FibroTest/FibroSure, Hepascore, and FibroSpect. Several serological tests panels of the ones that can be used in the assessment of liver fibrosis are: ActiTest, FIB-4 index, NAFLD fibrosis score, Fibro Index, Forns index, PGA index, Fibro-meter, BARD score, Lok index, GUCI, ELF, ALBI grade, Bonacini-index (CDS), King’s score, Pohl index, VITRO score, Zeng index.
- These serological tests can differentiate between patients with or without significant fibrosis. The major shortcoming might be that it cannot accurately distinguish between speficific levels of fibrosis.
- So far, none of the panels may be considered the standard evaluation of hepatic fibrosis and they are often complemented with Invasive procedures such as biopsy for more accurate results. Their usage depends on local availability.
Collaboration with Healthcare Providers for Optimal Diagnostic Strategy
- The best liver treatment doctor in Mumbai, India aka an expert gastroenterologist or hepatologist, primary care physician, and frequently specialists in infectious diseases, radiology, endocrinology, and psychology are involved in the best management of cirrhosis. Co-location in a single clinic would therefore be one method to enhance care.
- This strategy has improved care quality, preventive care, and guideline adherence in other chronic conditions like diabetes, coronary artery disease, and chronic obstructive pulmonary disease. Multidisciplinary treatment has also been demonstrated to improve outcomes in gastroenterology.
- Increased quality of life, slower disease progression, earlier stage diagnostics, and higher survival are all results of multidisciplinary hepatocellular carcinoma therapy; these benefits are probably due to the highly customized care that patients in these clinics receive. This success in other domains raises the possibility that one way to enhance outcomes for individuals with cirrhosis is through interdisciplinary clinics.
The diagnosis of liver fibrosis has advanced significantly due to the quick development of non-invasive technology. It does, however, provide difficulties for researchers and numerous issues for clinical trials. Patients will suffer greatly from unreliable results and careless professional decisions, which is why liver biopsy and non-invasive techniques should be utilized in tandem to enable more effective and convenient management of NAFLD patients.
Explore the advanced and latest medical technologies & techniques that the best liver transplant hospital in Mumbai, India offers. At, LTI you will find the best liver treatment doctors in India who operate with a team of top liver transplant healthcare providers that are committed towards providing best health services in liver transplant treatment.