Fatty Liver Reports and Tests: Ultrasound, LFT, and FibroScan

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What Ultrasound Can And Cannot Show

What Is An Ultrasound?

An ultrasound is a painless imaging test that uses high-frequency sound waves to create a picture of an organ, tissues, and blood flow inside the body. It does not use radiations thats why it is completely safe.

An abdominal ultrasound is often used as an initial test when fatty liver is suspected. It allows a doctor to look at the liver’s shape, size, and appearance. It can give a general idea of how the liver looks, but it cannot provide a complete picture of liver health. A fatty liver may appear bigger than normal on scan.

ALT/AST And Other Liver Tests

Liver blood tests help doctors understand whether the liver is under stress or whether there may be liver injury. These measure specific enzymes and proteins to evaluate liver health. They are usually interpreted together rather than relying on one result.

ALT (Alanine Aminotransferase)

ALT is an enzyme found mostly in the liver cells. When liver cells are injured, ALT can leak into the bloodstream, so a high level may indicate liver injury. However, ALT can sometimes be normal even when fatty liver is present, but it usually ranges from 7 to 56 units per litre in men and 7 to 40 units per litre in women.

AST (Aspartate Aminotransferase)

AST is another enzyme that can increase when cells are damaged. Unlike ALT, it is also found in muscles and other organs, so an increased AST does not always mean the problem is coming from the liver. It usually ranges between 8 to 48 U/L in men and 8 to 43 U/L in women

ALP (Alkaline Phosphate)

ALP is an enzyme associated with bile ducts and other tissues. A raised level can point towards a problem with bile flow; it can also increase for reasons unrelated to the liver. It normally ranges between 40 and 129 U/L.

GGT (Gamma- Glutamyl Transferase)

GGT is an enzyme associated with the liver and the bile ducts. It can increase with bile duct problems and can also be affected by alcohol, medicines, and other conditions. It usually ranges between 10 to 71 U/L in men and 6 to 42 U/L in women.

Bilirubin

Bilirubin is produced when old red blood cells are broken down. The liver processes it and helps remove it through bile. If bilirubin builds up, it can cause yellowing of the eyes or skin. It ranges from 3 to 17 micromoles per litre in adults.

Albumin 

Albumin is a protein made by the liver. Its level can provide information about the liver’s ability to make protein, although low albumin can also occur for several other reasons. It normally ranges from 3.5 to 5.0 g/dl.

A liver blood test is only one part of the assessment. Normal ALT and AST do not necessarily mean that the liver is completely healthy, and these tests cannot tell how much fat or fibrosis is present.

Why Fatty Liver Can Occur With Normal LFTs

Fatty liver can be present even when routine liver blood tests, often called LFTs (liver function tests), are within the normal range. This is because these tests mainly look for signs of liver cell injury, inflammation, or problems with liver function. They do not directly measure how much fat has accumulated in the liver.

A person may have excess fat stored in the liver cells without enough active cell injury to raise ALT or AST. Liver enzyme levels can vary over time and may not always reflect the severity of liver disease. So, normal LFTs cannot accurately measure fatty liver or early fibrosis. Doctors usually combine blood tests with ultrasound, FibroScan, and elastography for appropriate fat and fibrosis assessment.

What FibroScan Assesses

FibroScan is a non-invasive test used to assess the liver, mainly by measuring liver stiffness and liver fat. It can measure:

• Liver Stiffness: It estimates how stiff the liver is. Increased stiffness can suggest fibrosis (tissue scarring), although stiffness can also rise temporarily due to inflammation and other factors. FibroScan uses sound waves to calculate the speed of the wave passing through the liver. Stiffness is measured in kilopascals, ranging from F0 (healthy) to F4 (cirrhosis).
• Liver Fat (CAP): The Control Attenuation Parameter measures the amount of fat in the liver and helps estimate the degree of steatosis. CAP scores are measured in decibels per meter (db/m).

FibroScan does not directly show the liver under a microscope and cannot confirm MASH or determine the exact cause og liver damage by itself.

When Repeat Testing May Be Discussed

Repeated testing for fatty liver is considered when the doctor wants to monitor changes in your liver health over time or when initial results show abnormal or borderline enzyme levels. It may be discussed when:

• Liver enzymes are elevated and need to be rechecked.
• Fatty liver has already been identified, and ongoing monitoring is needed.
• There are risk factors for fibrosis or disease progression, such as diabetes, insulin resistance, obesity, and high cholesterol.
• Previous FibroScan for fibrosis or other tests showed an inappropriate result or a result that needs follow-up.
• Treatment has been started, and the doctor wants to check the response.
• New symptoms or other test results suggest that further evaluation may be needed.

The timing of reassessment may remain different. It depends on the initial results, the risk factors, symptoms and the test type.

Questions To Take To A Doctor

Discussing different questions with your doctor may help you better understand the situation, risk factors, severity, management, and follow-up.

These questions can help you understand your results and next steps:

• Do I have fatty liver and how is it confirmed?
• What do my ALT, AST, and other test results mean?
• Can I have fatty liver even if my LFTs are normal?
• Is there any indication of liver fibrosis or scarring?
• How often should my liver tests or scans be repeated?
• What lifestyle changes should I follow?
• How are my metabolic factors contributing to liver dysfunction?
• Do my blood tests show any liver injury, and how severe is it?
• Should I be referred to a specialist?
• Should I avoid any specific medicines, vitamins, or supplements?

Explore A Test-Specific Guide

Different tests help doctors understand different parts of fatty liver. Some look for liver injury, while others check fat buildup or scarring. Understanding what each test can and cannot identify makes it easy to understand your reports.

Reference

Correlation between FibroScan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis - PMC

Fibroscan - PMC

Diagnosis of NAFLD & NASH - NIDDK

Diagnosis of NAFLD - Non-Alcoholic Fatty Liver Disease - NCBI Bookshelf

Fatty Liver - StatPearls - NCBI Bookshelf