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Medically reviewed and verified by Kate Burke, MD, MHA
Metabolic dysfunction-associated steatohepatitis (MASH) is a liver condition often linked to metabolic health issues like obesity, diabetes, and high cholesterol. Diagnosing MASH can be challenging! There is no single test that provides a definitive diagnosis. It is also commonly called a "silent disease," because in its early stages it sometimes does not have any symptoms. Doctors use a combination of physical exams, blood tests, imaging techniques, and liver biopsy to diagnose MASH. Wondering what exactly that means for you? Here is a breakdown from PatientsLikeMe of the most common tests used to diagnose MASH, why they are used, and how effective they are.
At the Doctors
Medical History and Physical Examination
Doctors typically start by looking at your medical history and doing a physical exam. This helps them rule out other potential liver conditions and get a picture of your overall health. During the physical exam, doctors may:
- Calculate your body mass index (BMI): A high BMI is often linked with conditions like MASH.
- Look for signs of liver problems: This might mean checking for an enlarged liver or other symptoms of metabolic dysfunction. They will look for darkened patches of skin on the knuckles, elbows, or knees.
- Check for signs of advanced liver damage: An enlarged spleen, fluid buildup in the abdomen (ascites), or muscle loss may mean cirrhosis. This is a more severe form of liver damage.
Physical exams cannot confirm a MASH diagnosis. However, they give doctors valuable clues that inform further testing.
Blood Tests
Blood tests are a common first step in diagnosing MASH. These tests can check liver health and identify related conditions. The most common test is a liver enzyme test. Here, doctors measure levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). High levels may mean liver damage, although not everyone with MASH has abnormal results.
Results from routine blood tests may be used to calculate scores like the FIB-4 or APRI, which help estimate the likelihood of advanced fibrosis (scarring of the liver). Additional blood tests can help rule out other causes of elevated liver enzymes, like viral hepatitis or autoimmune diseases.
Imaging Tests
Imaging is a painless and non-invasive way to look at the liver. Doctors often start with basic imaging techniques and may progress to more advanced tests.
Routine Imaging
- Ultrasound: This common test uses sound waves to create pictures of the liver. It can detect liver enlargement and fat content but cannot show inflammation or fibrosis.
- Computed tomography (CT) scan: A CT scan also gives doctors detailed images of the liver and can identify fat accumulation. However, like ultrasound, it does not reveal inflammation or fibrosis.
- Magnetic resonance imaging (MRI): MRI uses magnets and radio waves to produce detailed images of the liver. It is more precise than ultrasound and CT for detecting fat but still cannot confirm inflammation or scarring.
Specialized Imaging
- Transient elastography (FibroScan): This is an advanced ultrasound that measures liver stiffness, which can indicate fibrosis. It also assesses liver fat.
- Magnetic resonance elastography (MRE): A special type of MRI, MRE measures liver stiffness with even greater accuracy than FibroScan. It is particularly good at assessing fibrosis and inflammation.
Liver Biopsy
A liver biopsy is considered the gold standard for diagnosing MASH because it provides direct evidence of liver inflammation, fat accumulation, and scarring. During this minimally invasive procedure, a doctor uses a thin needle to take out a small piece of liver tissue. They then look at the sample under a microscope to figure out the severity of the disease.
While a liver biopsy is highly accurate, it has limitations:
- Invasiveness: The procedure carries risks, such as bleeding or infection.
- Variability: Results can differ depending on the sample or the doctor’s interpretation.
- Patient discomfort: Many people find the procedure unpleasant.
For these reasons, liver biopsies are typically reserved for cases where other tests suggest advanced liver damage or when other liver diseases need to be ruled out.
Emerging Non-Invasive Tests (NITS)
Recently, new non-invasive tests have been developed to improve the accuracy of a MASH diagnosis while minimizing discomfort. These tests combine imaging techniques with blood test data to give doctors a comprehensive picture of liver health.
- FAST score: This combines FibroScan results with blood tests to estimate liver damage, including fibrosis and inflammation. It offers a precise and patient-friendly alternative to biopsy.
- MAST score: This test uses MRI data to assess liver fat, inflammation, and scarring. Complemented by specific blood tests, it is highly accurate but needs more validation.
- MEFIB: Another MRI-based test, MEFIB combines imaging with blood test results to help doctors assess liver disease.
These new approaches are a shift towards less invasive, more patient-centered diagnostics. While these methods are promising, they are still being studied and validated for widespread use.
Diagnosing MASH takes a combination of tests, each with its own strengths and limitations. While liver biopsy remains the most accurate test, non-invasive techniques like FibroScan, MRE, and advanced scoring systems are making diagnosis easier and more comfortable for patients. These advancements are particularly important for managing MASH, as early detection can prevent progression to severe liver damage. If you think you might have MASH or are at risk due to metabolic health issues, talk to your doctor!
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