Plain-language guides on liver blood tests, imaging, elastography, and fibrosis scoring — built on peer-reviewed research and current clinical guidelines. Everything a newly diagnosed patient needs, in one place.
14+In-depth guides
5Interactive calculators
2024–25Guideline-aligned
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A liver diagnosis — whether it's fatty liver disease (MASLD), elevated enzymes, a worrying FibroScan result, or something more advanced — comes with a mountain of unfamiliar terminology. Your doctor hands you a lab report filled with abbreviations: ALT, AST, GGT, FIB-4, LSM, CAP. You're told to "monitor things" without always understanding what you're monitoring or why it matters.
The LiverDecoded Guide exists to fix that. Every article here is written to give you two things: a genuine understanding of what each test measures biologically, and practical context for interpreting your own results. We back every claim with references to peer-reviewed research and current clinical guidelines (AASLD, EASL-EASD-EASO 2024, Baveno VII), because you deserve accurate information — not just reassurance.
Use the guides below as a self-directed curriculum. Most newly diagnosed patients should start with the blood test section, then move into imaging and elastography as needed. Calculators are embedded in the relevant guides so you can apply the concepts immediately.
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Liver Health Calculators
These calculators use values from your routine blood tests and FibroScan results to generate validated clinical scores. Enter your numbers once and get an instant risk assessment with plain-language interpretation.
New to this? Start with the Comprehensive Calculator
If you have a recent blood test, the Comprehensive Liver Risk Assessment tool calculates nine scores at once — FIB-4, AGILE 3+, AGILE 4, NFS, APRI, FLI, SAFE, FNI, and LSM — so you can see your full risk picture in a single step.
Liver blood tests fall into two categories that are often confused: enzyme markers (ALT, AST, GGT, ALP) that signal inflammation or cell injury, and true function tests (bilirubin, albumin, INR) that measure whether the liver is actually doing its job. Understanding this distinction is the foundation of reading any liver report.
Blood tests tell you something is wrong. Imaging tells you what it looks like and where. Abdominal ultrasound is almost always the first imaging test ordered for suspected fatty liver — it's non-invasive, cheap, and widely available. But it has real limitations in grading steatosis and detecting fibrosis, which is where advanced imaging takes over.
Elastography measures liver stiffness — and stiffer livers typically have more fibrosis. FibroScan (VCTE) is the most widely used technique, but several alternatives exist with different accuracy profiles, probe requirements, and availability. This section covers each technology in depth so you can understand what your result actually means.
The diagnostic pathway: from FIB-4 to FibroScan to AGILE
Current EASL and AASLD guidelines recommend a stepwise approach: use FIB-4 first to triage patients, refer those with indeterminate or high-risk scores for FibroScan or equivalent elastography, then use AGILE 3+ and AGILE 4 to integrate both results for the most accurate fibrosis staging. Our calculators are built around this exact pathway.
This distinction confuses many patients — and even some clinicians. Liver enzymes (ALT, AST, GGT, ALP) leak out of damaged or inflamed liver cells and signal injury, but they don't directly measure what the liver is producing or excreting. True liver function tests (bilirubin, albumin, PT/INR) measure actual hepatic output — how well the liver is processing waste, making proteins, and synthesising clotting factors. You can have severely elevated enzymes with normal function, or near-normal enzymes with impaired function in advanced fibrosis. Both panels together give the complete picture.
A FIB-4 between 1.30 and 2.67 (for patients ≤65 years) means the score cannot reliably rule in or rule out significant fibrosis. This is an expected result for a significant proportion of patients — the FIB-4 is designed as a triage tool, not a definitive answer. An indeterminate result is typically an indication for further assessment, which may include FibroScan (VCTE), alternative elastography, or an ELF blood panel, depending on what's available and your clinical picture.
Not necessarily. While higher LSM values (generally above 12–15 kPa in MASLD, depending on the guideline) suggest advanced fibrosis or cirrhosis, FibroScan can produce falsely elevated readings due to several confounders: acute hepatitis (inflammation transiently raises stiffness), recent food intake (2 hours before testing), congested heart failure, and biliary obstruction. A result should always be interpreted alongside your blood tests, clinical history, and ideally an AGILE 3+ or AGILE 4 score that contextualises the LSM within a more complete model.
Yes. While LiverDecoded has a particular focus on MASLD/fatty liver disease, the blood test and elastography guides are relevant to any chronic liver condition. The enzyme patterns differ somewhat between viral hepatitis and metabolic disease — for example, the ALT/AST ratio behaves differently — and these nuances are covered in the relevant guides. Our comprehensive eBook also includes chapters specifically on hepatitis B and C testing panels, autoimmune markers, and disease-specific tests.
Our guides reflect the most recent major guidelines: AASLD 2024, EASL-EASD-EASO 2024 (the European joint guideline on MASLD), and Baveno VII for portal hypertension. Each guide includes the references used so you can verify the primary sources. We update content as major guideline changes occur.
Go Deeper with the Liver Health Book Series
Two comprehensive patient guides — Book 1 on all 50+ blood tests, Book 2 on every imaging and diagnostic technique. 300+ combined pages, fully referenced, written in plain language.
Medical disclaimer: The guides on this site are for educational purposes only. They explain what tests measure and how results are typically interpreted. They do not constitute medical advice, diagnosis, or treatment recommendations for any individual. Always consult a qualified healthcare provider before making any decisions about your health or treatment.