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ForumsMASH / Liver DiseaseHepatic steatosis grading on ultrasound — July 2024

Hepatic steatosis grading on ultrasound — July 2024

traveltech_sara Sun, Mar 16, 2025 at 11:06 AM 28 replies 1,920 viewsPage 1 of 6
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traveltech_sara
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Mar 16, 2025 at 11:06 AM#1

ALT was mildly raised at baseline, normalised at month five, and I now have no idea whether anything happened to the fibrosis that actually matters.

So the question, as narrowly as I can put it: whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is.

I have searched first, so if this is covered somewhere point me at it and I will read it.

50 20MeganSA_TX, LarryQC_SD, wanda_boise and 47 others
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Dr.RenalNash
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Mar 16, 2025 at 11:11 AM#2
traveltech_sara said:
ALT was mildly raised at baseline, normalised at month five, and I now have no idea whether anything happened to the fibrosis that actually matters.

Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD). After 10 months on GLP-1 therapy:

MarkerBaselineCurrentNormal Range
ALT69267-56 U/L
AST522010-40 U/L
GGT69329-48 U/L
ALP997644-147 U/L

FibroScan also improved — liver stiffness from 9.5 kPa to 5.2 kPa. The evidence for GLP-1 agonists in NAFLD/NASH is very promising.

49 19pam_stl, wei_SG, cory_ATX and 46 others
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CryptoCarl
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Mar 16, 2025 at 11:16 AM#3
Dr.RenalNash said:
Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD).

ATTAIN trial (survodutide) context for liver and MASH: survodutide, a GLP-1/glucagon dual agonist, showed -18.7% body weight at 46 weeks in the Phase 3 ATTAIN trial. NASH resolution was achieved in ~60% of patients[1].

This is relevant to liver and MASH because survodutide's glucagon agonism specifically targets hepatic lipid metabolism — making it potentially the best-in-class agent for NASH/MAFLD comorbid with obesity.

References:
[1] Sanyal AJ, et al. N Engl J Med. 2024.
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FitDadDave
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Mar 16, 2025 at 11:21 AM#4
traveltech_sara said:
ALT was mildly raised at baseline, normalised at month five, and I now have no idea whether anything happened to the fibrosis that actually matters.

Mine went the same way, slower. I had assumed I was the exception until I read this.

Last edited: Mar 16, 2025 at 2:21 PM
47 17wendy_avl, jason_paloalto, Dr.LeslieOBGYN and 44 others
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hyun_seoul
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Mar 16, 2025 at 11:47 AM#5

Adding the clinical framing, because it changes how the question reads.

Liver ultrasound comparison for liver and MASH: my hepatologist ordered serial ultrasounds to track NAFLD regression.

Baseline: "Moderate hepatic steatosis, liver span 17.2cm, echogenic texture consistent with fat infiltration"
Month 8: "Mild steatosis, liver span 15.8cm, improved echogenicity"
Month 14: "Minimal to no steatosis, normal liver span 14.5cm, normal echotexture"

My liver literally shrank and de-fattened. The ultrasound tech said she's seen this pattern increasingly in GLP-1 patients and it's remarkable how consistently the fatty liver resolves.

Last edited: Mar 16, 2025 at 3:47 PM
46 16LipidDoc_ATL, BariatricNurseD, MASHdoc_SA and 43 others
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