Deciphering the Non-invasive Tests in NAFLD: A Systematic Review and Meta-analyses

Background: Non-alcoholic fatty liver disease (NAFLD) is a significant health issue worldwide now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), varying from mild fat accumulation in the liver to non-alcoholic steatohepatitis (NASH). Aim and objective: The primary aim of this study was to answer the question:” How does the combination of non-invasive tests help in enhancing the accuracy for advancing fibrosis in NAFLD patients and how this could assist in clinical practice and management?”. Methods: The systematic review and meta-analyses included studies published from 2016 to 2024 assessing non-invasive tests (NITs) in the diagnosis of advanced fibrosis in NAFLD patients across Scopus, PubMed and Embase. Fifteen studies were finally selected with seven studies included in the meta-analyses. Results: The pooled estimates for mean AUC, sensitivity and specificity for various NITs were 0.82, 0.53 and 0.83 respectively. Magnetic resonance elastography (MRE) and enhanced liver fibrosis (ELF) tests showed high accuracy in the diagnosis of advanced fibrosis. Conclusion: A combination of non-invasive tests will aid in enhancing the accuracy of fibrosis detection and progression in NAFLD improving patient outcomes. Emerging methods like the use of AI and ML, microRNA signatures, optical coherence tomography, and future directions including liquid biopsy and molecular imaging techniques show promising results in the diagnostic performance and accuracy of NAFLD.