Appears steatosis on ultrasound

Obligatory medical device diagnostics

  • Liver sonography (Ultrasound examination of the liver) - for the basic diagnosis of non-alcoholic fatty liver (NAFLD) [steatosis hepatis (fatty liver): see echogenicity liver with renal cortex (normal: isoechogenic; steatosis hepatis: liver hyperechoic); Sensitivity (percentage of sick patients in whom the disease is recognized by the application of the method, ie a positive result occurs) 60-94%, specificity (probability that actually healthy people who do not suffer from the disease in question are also recognized by the method as recognized healthy) 66-97%; the positive predictive value (PPV) for mild steatosis (fatty liver cells) is a maximum of 67%]
    (Sonographic follow-up every six months for non-alcoholic steatohepatitis, NASH)
    • The sensitivity of liver sonography is only acceptable for a degree of steatosis above 30%.
    • The ultrasound does not allow the exclusion of hepatic steatosis and no distinction between NAFLD and NASH (strong consensus) [1]

Facultative medical device diagnostics - depending on the results of the anamnesis, physical examination, laboratory diagnostics and mandatory medical device diagnostics - for differential diagnostic clarification

  • Electrical impedance analysis (measurement of body compartments / body composition) - to determine body fat, extracellular body mass (blood and tissue fluid), body cell mass (muscle and organ mass) and total body water including measurement of body mass index (BMI, body mass index), Waist-to-hip ratio (THV) and blood pressure
  • Ultrasound-based shear wave elastography method - can be used to exclude an advanced Liver fibrosis and Liver cirrhosis in NASH are used [1]
    Note: A differentiation between steatohepatitis and fibrosis using elastography is not possible [1].
  • Transient elastography (TE, Fibrosan; ultrasound method that measures the degree of connective tissue in the liver) - to assess the stage of liver fibrosis
  • Magnetic resonance elastography - enables statements to be made about the degree of fibrosis
  • Magnetic Resonance Spectroscopy (MR-S) - to accurately quantify fat in the liver; However, due to the lack of implementation of the appropriate hardware and software, it has not yet reached clinical routine. (strong consensus) [1]
  • Phosphorus-based magnetic resonance spectroscopy - to differentiate between simple fatty liver and non-alcoholic steatohepatitis
  • Liver puncture(Liver biopsy; gold standard) [1]:
    • Histological confirmation may be necessary to rule out other liver diseases (strong consensus) [1]
    • in patients with NAFLD and positive autoantibodies, if there is sufficient suspicion of autoimmune hepatitis (AIH; autoimmune hepatitis), as this can result in specific therapeutic consequences. (strong consensus) (recommendation) [1]
  • Laparoscopy (laparoscopy) - if the findings are unclear

More information

  • A transient elastography of 3,076 healthy adults from the metropolitan area of ​​Barcelona found increased liver stiffness (≥ 6.8 kPa) in 9 percent of the study participants. A liver biopsy was offered to those affected; 92 of them agreed. Doctors diagnosed non-alcoholic fatty liver disease (NAFLD) in 81 participants and alcoholic liver disease in seven. The remaining four patients showed no histological (tissue) abnormalities [2].
  • Calculation of the non-invasive fibrosis score (e.g. NAFLD fibrosis score; parameters age, BMI (body mass index (BMI; body mass index (KMI)), diabetes mellitus, AST (GOT), ALT (GPT), platelets and albumin): NAFLD fibrosis score


  1. S2k guideline: Non-alcoholic fatty liver diseases. (AWMF registration number: 021-025), February 2015 long version
  2. Caballeria L et al .: High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study. Clin Gastroenterol Hepatol. 2018 Feb 13. pii: S1542-3565 (18) 30006-5. doi:


  1. S2k guideline: Non-alcoholic fatty liver diseases. (AWMF registration number: 021-025), February 2015 long version
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