title: A comprehensive review of noninvasive liver fibrosis tests in pediatric nonalcoholic Fatty liver disease.
abstract: Nonalcoholic fatty liver disease (NAFLD) and its spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) and fibrosis have been increasing in the pediatric population. The presence and severity of fibrosis in patients with NAFLD are important prognostic factors for the risk of disease progression to cirrhosis. The gold standard for staging liver fibrosis is a liver biopsy. However, given the risks of this procedure, especially in the pediatric population, the development of noninvasive markers to diagnose and monitor progression of NAFLD is desirable. This paper will review recently developed noninvasive methods for diagnosing liver fibrosis in children with NAFLD. These include simple fibrosis scores, advanced biochemical markers, and radiologic imaging studies. Simple fibrosis scores use readily available laboratory tests; available one include AST/ALT ratio, AST to platelet ratio index (APRI), fibrosis (FIB)-4 index, NAFLD fibrosis score (NFS), pediatric NAFLD fibrosis index (PNFI), and pediatric NALFD fibrosis score (PNFS). Advanced biochemical markers include biomarkers of hepatocyte cell death such as cytokeratin 18 fragment levels, and markers of extracellular matrix turnover such as the Enhanced Liver Fibrosis (ELF) test and hyaluronic acid. Radiologic imaging studies estimate liver stiffness as a surrogate for liver fibrosis; these include transient elastography (TE), magnetic resonance elastography (MRE), and acoustic radiation force impulse imaging (ARFI).
authors.affiliation: Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, mansoos@ccf.org.
authors.forename: Sana
authors.initials: S
authors.lastname: Mansoor
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Collyer
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D011379:Prognosis; D012372:ROC Curve; D014463:Ultrasonography
chemical_list: D015415:Biomarkers