Non-alcoholic steatohepatitis (NASH) Elastography versus Liver Biopsy

Non-alcoholic steatohepatitis (NASH) is increasing in incidence alongside obesity and diabetes. Untreated NASH leads to cirrhosis, which emphasizes the importance of early diagnosis and continual monitoring of patients at high risk of disease progression. Historically, diagnosis has relied on liver biopsy; however, elastography is a noninvasive means of identifying NASH characteristics. A single institution retrospective correlation of biopsies and elastography between 3/1/16 and 5/1/21 on patients with NASH was completed. Those on NASH studies and those with incomplete records were excluded. Typical demographic and clinicopathologic data were collected to include imaging and histology findings. Overall, 25 patients were included in the study. Of these patients, 88% were white, and 60% were female. The average age of our cohort was 56.6 (35-73). Mean BMI was 31.80 (24.06-42.20), and 60% of patients were obese. Moreover, 96% of patients were overweight, and none were underweight, while 72% had diabetes. A comparison of proportions was performed to evaluate the efficacy of biopsy versus elastography for fibrosis and cirrhosis. There was a statistically significant difference between the categories of elastography and histology in agreement versus those opposed for both fibrosis and cirrhosis, suggesting that they have similar capabilities in recognizing later stages of NASH. However, regarding elastography, none of the imaging definitively noted steatosis or inflammation. For histologic analysis, steatosis was identified in 88% of specimens, and inflammation was apparent in 92% of specimens. These data reveal that histology more readily confirmed early defining features of NASH, while elastography posed difficulty differentiating fibrosis and biologic confounders, supporting histology as the gold standard for initial NASH diagnosis