{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:33:21Z","timestamp":1790249601221,"version":"4.1.0"},"reference-count":59,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Glympse Bio"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The purpose of this systematic literature review (SLR) was to evaluate the accuracy of noninvasive diagnostic tools in detecting significant or advanced (F2\/F3) fibrosis among patients with nonalcoholic fatty liver (NAFL) in the US healthcare context. Methods: The SLR was conducted in PubMed and Web of Science, with an additional hand search of public domains and citations, in line with the PRISMA statement. The study included US-based original research on diagnostic test sensitivity, specificity and accuracy. Results: Twenty studies were included in qualitative evidence synthesis. Imaging techniques with the highest diagnostic accuracy in F2\/F3 detection and differentiation were magnetic resonance elastography and vibration-controlled transient elastography. The most promising standard blood biomarkers were NAFLD fibrosis score and FIB-4. The novel diagnostic tools showed good overall accuracy, particularly a score composed of body mass index, GGT, 25-OH-vitamin D, and platelet count. The novel approaches in liver fibrosis detection successfully combine imaging techniques and blood biomarkers. Conclusions: While noninvasive techniques could overcome some limitations of liver biopsy, a tool that would provide a sufficiently sensitive and reliable estimate of changes in fibrosis development and regression is still missing.<\/jats:p>","DOI":"10.3390\/diagnostics12112608","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T20:37:58Z","timestamp":1666903078000},"page":"2608","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Accuracy of Noninvasive Diagnostic Tests for the Detection of Significant and Advanced Fibrosis Stages in Nonalcoholic Fatty Liver Disease: A Systematic Literature Review of the US Studies"],"prefix":"10.3390","volume":"12","author":[{"given":"Dhaval","family":"Gosalia","sequence":"first","affiliation":[{"name":"Department of Commercial Strategy and Operations, Glympse Bio, Cambridge, MA 02140, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad","family":"Ratziu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medicine Sorbonne University, 75013 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2293-8940","authenticated-orcid":false,"given":"Filip","family":"Stanicic","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON L5A 2X7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9591-1111","authenticated-orcid":false,"given":"Djurdja","family":"Vukicevic","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON L5A 2X7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Zah","sequence":"additional","affiliation":[{"name":"Health Economics and Outcomes Research Department, ZRx Outcomes Research Inc., Mississauga, ON L5A 2X7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadege","family":"Gunn","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Impact Research Institute, Waco, TX 76710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Halegoua-DeMarzio","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tram","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Medicine, UCLA Santa Monica Medical Center, Santa Monica, CA 90404, USA"},{"name":"Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2862173","DOI":"10.1155\/2016\/2862173","article-title":"The Pathogenesis of Nonalcoholic Fatty Liver Disease: Interplay between Diet, Gut Microbiota, and Genetic Background","volume":"2016","author":"Yu","year":"2016","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"215","DOI":"10.14218\/JCTH.2020.00014","article-title":"NAFLD Epidemiology, Emerging Pharmacotherapy, Liver Transplantation Implications and the Trends in the United States","volume":"8","author":"Gadiparthi","year":"2020","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/joim.13069","article-title":"Prevalence, characteristics and mortality outcomes of obese, nonobese and lean NAFLD in the United States, 1999\u20132016","volume":"288","author":"Zou","year":"2020","journal-title":"J. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.jhep.2010.04.031","article-title":"Hepatocellular ballooning in NASH","volume":"53","author":"Caldwell","year":"2010","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.gtc.2016.07.003","article-title":"Nonalcoholic Fatty Liver Disease: Pathophysiology and Management","volume":"45","author":"Carr","year":"2016","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1002\/hep4.1479","article-title":"Pathogenesis of Nonalcoholic Steatohepatitis: An Overview","volume":"4","author":"Parthasarathy","year":"2020","journal-title":"Hepatol. Commun."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100089","DOI":"10.1016\/j.endmts.2021.100089","article-title":"The global epidemiology of nonalcoholic steatohepatitis (NASH) and associated risk factors\u2014A targeted literature review","volume":"3","author":"Dufour","year":"2021","journal-title":"Endocr. Metab. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"674","DOI":"10.5009\/gnl16440","article-title":"Noninvasive Assessment of Advanced Fibrosis Based on Hepatic Volume in Patients with Nonalcoholic Fatty Liver Disease","volume":"11","author":"Hayashi","year":"2017","journal-title":"Gut Liver"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/hep.29721","article-title":"Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis","volume":"68","author":"Younossi","year":"2018","journal-title":"Hepatology"},{"key":"ref_11","unstructured":"Lee, T.H., and Peters, J.J. (2022, July 25). Hepatic Fibrosis: MSD Manual Professional Version. Available online: https:\/\/www.msdmanuals.com\/professional\/hepatic-and-biliary-disorders\/fibrosis-and-cirrhosis\/hepatic-fibrosis?query=hepatic%20fibrosis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.aohep.2020.01.003","article-title":"Prevalence of liver fibrosis in an unselected general population with high prevalence of obesity and diabetes mellitus. Time for screening?","volume":"19","author":"Cavazos","year":"2020","journal-title":"Ann. Hepatol."},{"key":"ref_13","first-page":"721","article-title":"High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients","volume":"15","author":"Arab","year":"2016","journal-title":"Ann. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Dvorak, K., Stritesky, J., Petrtyl, J., Vitek, L., Sroubkova, R., Lenicek, M., Smid, V., Haluzik, M., and Bruha, R. (2014). Use of non-invasive parameters of non-alcoholic steatohepatitis and liver fibrosis in daily practice\u2014An exploratory case-control study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0111551"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1111\/liv.14828","article-title":"Prevalence of NAFLD, MAFLD and associated advanced fibrosis in the contemporary United States population","volume":"41","author":"Ciardullo","year":"2021","journal-title":"Liver Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/hep.27368","article-title":"Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up","volume":"61","author":"Ekstedt","year":"2015","journal-title":"Hepatology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1002\/hep.29085","article-title":"Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis","volume":"65","author":"Dulai","year":"2017","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S113","DOI":"10.1002\/hep.21046","article-title":"Noninvasive measures of liver fibrosis","volume":"43","author":"Rockey","year":"2006","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s00330-020-07114-y","article-title":"Diagnostic value of MRI-derived liver surface nodularity score for the non-invasive quantification of hepatic fibrosis in non-alcoholic fatty liver disease","volume":"31","author":"Catania","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"106174","DOI":"10.1016\/j.cct.2020.106174","article-title":"Semaglutide for the treatment of non-alcoholic steatohepatitis: Trial design and comparison of non-invasive biomarkers","volume":"97","author":"Harrison","year":"2020","journal-title":"Contemp. Clin. Trials"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jhep.2018.09.024","article-title":"Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: Analysis of data from a phase II trial of selonsertib","volume":"70","author":"Jayakumar","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/j.ultrasmedbio.2019.12.020","article-title":"Diagnostic Accuracy of Shear Wave Elastography as a Non-Invasive Biomarker of High-Risk Non-Alcoholic Steatohepatitis in Patients with Non-Alcoholic Fatty Liver Disease","volume":"46","author":"Ozturk","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.cgh.2020.03.067","article-title":"Diagnostic Performance of Vibration-Controlled Transient Elastography in Liver Transplant Recipients","volume":"19","author":"Siddiqui","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2937","DOI":"10.1007\/s00330-021-08381-z","article-title":"MR elastography in nonalcoholic fatty liver disease: Inter-center and inter-analysis-method measurement reproducibility and accuracy at 3T","volume":"32","author":"Tang","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s10620-020-06269-4","article-title":"How Good Are Controlled Attenuation Parameter Scores from Fibroscan to Assess Steatosis, NASH, and Fibrosis?","volume":"66","author":"Trowell","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1007\/s00330-021-08369-9","article-title":"Comparative diagnostic performance of ultrasound shear wave elastography and magnetic resonance elastography for classifying fibrosis stage in adults with biopsy-proven nonalcoholic fatty liver disease","volume":"32","author":"Zhang","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1007\/s10620-020-06501-1","article-title":"External Validation of Four Point-of-Care Noninvasive Scores for Predicting Advanced Hepatic Fibrosis in a Predominantly Hispanic NAFLD Population","volume":"66","author":"Balakrishnan","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2337\/dc19-1071","article-title":"Performance of Plasma Biomarkers and Diagnostic Panels for Nonalcoholic Steatohepatitis and Advanced Fibrosis in Patients with Type 2 Diabetes","volume":"43","author":"Bril","year":"2020","journal-title":"Diabetes Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1136\/gutjnl-2018-317584","article-title":"Serum metabolites detect the presence of advanced fibrosis in derivation and validation cohorts of patients with non-alcoholic fatty liver disease","volume":"68","author":"Caussy","year":"2019","journal-title":"Gut"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jhep.2021.09.026","article-title":"ADAMTSL2 protein and a soluble biomarker signature identify at-risk non-alcoholic steatohepatitis and fibrosis in adults with NAFLD","volume":"76","author":"Corey","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e12472","DOI":"10.1111\/cob.12472","article-title":"A clinical model to predict fibrosis on liver biopsy in paediatric subjects with nonalcoholic fatty liver disease","volume":"11","author":"Kulkarni","year":"2021","journal-title":"Clin. Obes."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e00165","DOI":"10.14309\/ctg.0000000000000165","article-title":"Accuracy of Noninvasive Fibrosis Scoring Systems in African American and White Patients with Nonalcoholic Fatty Liver Disease","volume":"11","author":"Marella","year":"2020","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.jhep.2021.08.016","article-title":"Comparison of ADAPT, FIB-4 and APRI as non-invasive predictors of liver fibrosis and NASH within the CENTAUR screening population","volume":"75","author":"Nielsen","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1097\/MCG.0000000000001339","article-title":"Accuracy of Noninvasive Fibrosis Scores to Detect Advanced Fibrosis in Patients with Type-2 Diabetes with Biopsy-Proven Nonalcoholic Fatty Liver Disease","volume":"54","author":"Singh","year":"2020","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.soard.2020.09.037","article-title":"Use of noninvasive scores for advanced liver fibrosis can guide the need for hepatic biopsy during bariatric procedures","volume":"17","author":"Udelsman","year":"2021","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e2123923","DOI":"10.1001\/jamanetworkopen.2021.23923","article-title":"Performance of the Enhanced Liver Fibrosis Test to Estimate Advanced Fibrosis among Patients with Nonalcoholic Fatty Liver Disease","volume":"4","author":"Younossi","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1136\/gutjnl-2020-322976","article-title":"MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis","volume":"70","author":"Jung","year":"2021","journal-title":"Gut"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Woreta, T.A., Van Natta, M.L., Lazo, M., Krishnan, A., Neuschwander-Tetri, B.A., Loomba, R., Mae Diehl, A., Abdelmalek, M.F., Chalasani, N., and Gawrieh, S. (2022). Validation of the accuracy of the FAST\u2122 score for detecting patients with at-risk nonalcoholic steatohepatitis (NASH) in a North American cohort and comparison to other non-invasive algorithms. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0266859"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ejrad.2017.11.003","article-title":"MR elastography is effective for the non-invasive evaluation of fibrosis and necroinflammatory activity in patients with nonalcoholic fatty liver disease","volume":"98","author":"Ferolla","year":"2018","journal-title":"Eur. J. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/liv.13058","article-title":"Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection","volume":"36","author":"Dyvorne","year":"2016","journal-title":"Liver Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1503\/cmaj.1040752","article-title":"Liver enzyme alteration: A guide for clinicians","volume":"172","author":"Giannini","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/apt.16760","article-title":"Long-term prognosis of patients with metabolic (dysfunction)-associated fatty liver disease by non-invasive methods","volume":"55","author":"Decraecker","year":"2022","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1002\/hep.30842","article-title":"Noninvasive Tests Accurately Identify Advanced Fibrosis due to NASH: Baseline Data from the STELLAR Trials","volume":"70","author":"Anstee","year":"2019","journal-title":"Hepatology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.cgh.2018.05.059","article-title":"Magnetic Resonance vs. Transient Elastography Analysis of Patients with Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants","volume":"17","author":"Hsu","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2214\/AJR.19.21144","article-title":"Current Imaging Techniques for Noninvasive Staging of Hepatic Fibrosis","volume":"213","author":"Smith","year":"2019","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jhep.2017.11.013","article-title":"Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers","volume":"68","author":"Chalasani","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_48","unstructured":"Sanyal, A.J., Shankar, S.S., Yates, K., Daly, E., Bolognese, J.A., Neuschwander-Tetri, B.A., Kowdley, K.V., Vuppalanchi, R., Guy, C.A., and Tonascia, J. (2021). Primary Results of the NIMBLE Stage 1-NASH CRN Study of Circulating Biomarkers for Nonalcoholic Steatohepatitis and Its Activity and Fibrosis Stage, American Association for the Study of Liver Diseases."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver, European Association for the Study of Diabetes, and European Association for the Study of Obesity (2016). EASL\u2013EASD\u2013EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J. Hepatol., 64, 1388\u20131402.","DOI":"10.1016\/j.jhep.2015.11.004"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2021). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis\u20142021 update. J. Hepatol., 75, 659\u2013689.","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.clinthera.2021.07.012","article-title":"Current and Emerging Biomarkers and Imaging Modalities for Nonalcoholic Fatty Liver Disease: Clinical and Research Applications","volume":"43","author":"Hydes","year":"2021","journal-title":"Clin. Ther."},{"key":"ref_52","first-page":"25","article-title":"Systematic review of existing guidelines for NAFLD assessment","volume":"7","author":"Monelli","year":"2021","journal-title":"Hepatoma Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1136\/gutjnl-2019-318813","article-title":"Epidemiology of chronic liver diseases in the USA in the past three decades","volume":"69","author":"Younossi","year":"2020","journal-title":"Gut"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/S2468-1253(17)30142-5","article-title":"Too much medicine: Overdiagnosis and overtreatment of non-alcoholic fatty liver disease","volume":"3","author":"Rowe","year":"2018","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/liv.14669","article-title":"Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review","volume":"41","author":"Lee","year":"2021","journal-title":"Liver Int."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1053\/j.gastro.2005.03.084","article-title":"Sampling variability of liver biopsy in nonalcoholic fatty liver disease","volume":"128","author":"Ratziu","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"k2734","DOI":"10.1136\/bmj.k2734","article-title":"Tests for diagnosing and monitoring non-alcoholic fatty liver disease in adults","volume":"362","author":"Byrne","year":"2018","journal-title":"Bmj"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/00325481.2019.1546532","article-title":"Clinical workup of fatty liver for the primary care provider","volume":"131","author":"Jensen","year":"2019","journal-title":"Postgrad. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/hepr.13745","article-title":"2-Step PLT16-AST44 method: Simplified liver fibrosis detection system in patients with non-alcoholic fatty liver disease","volume":"52","author":"Fujimori","year":"2022","journal-title":"Hepatol. Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/11\/2608\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:04:21Z","timestamp":1760144661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/11\/2608"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,27]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["diagnostics12112608"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12112608","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,27]]}}}