Hello there @leonorleans,

I know everyone’s situation is different, but my particular case presented somewhat like yours in regards to the MRI. I had bloodwork (currently my ALT is just one point outside the normal range, but it was on the high end of normal the test before this) and the numbers were perplexing with some in the high range and others in the middle of the normal range.

Because of my elevated numbers, they ordered an MRI, further bloodwork, and genetic testing (due to family history and grandmother’s passing with liver cancer).

My first MRI showed a slight dilation, but upon having another one done at the time I had a liver biopsy, it did not show a dilation. The results came back “near-normal histological appearance. Features suspicious for focal perioductal concentric fibrosis. Features suspicious for mild periportal fibrosis on trichrome stain.”

My bloodwork showed I had a positive FANA (checking for autoimmune disease), I hurt all over and had some unexpected symptoms that were not the norm. The doctors said they were looking to rule out autoimmune hepatitis which was also the reason they wanted a biopsy. They informed me there are some conditions that do not show on an MRI that require a biopsy to diagnose/rule out. In my particular case I ended up diagnosing with primary sclerosing cholangitis (PSC) of the small ducts. I was told the large duct version can show with imaging, but small duct can only be confirmed with a biopsy.

I’ve been referred to many different specialties while they were trying to determine the root cause of my elevated numbers which also included a dietitian (a second referral following my liver disease diagnosis). The strangest part, to me, was my blood sugar level would drop after eating certain foods. My PGP actually sent me to begin this journey via digestive clinic because I was having stomach pain and thought I had non diabetic hypoglycemia. It was the digestive clinic that ran the first set of tests (my hepatic specialist is in their offices so I’m lucky).

My symptoms only appeared when my numbers were at their peak of elevation, joint pain, itching, stomach pain, brain fog, fatigue, altered stools, etc. The endocrinologist suggested a “green Mediterranean diet “ which is more plant forward and I try to stay at 30 grams of fat or less per day which helps keep my symptoms from popping up again.

I am by no means saying you should do anything in particular, but perhaps ask your doctor about other possible liver diseases that could cause an elevated ALT number while others are in the normal range. Again, mine have returned to the upper level of normal for the most part aside from this last visit where it was one point above normal. My hepatic specialist was very helpful and told me what he was hoping to rule out and why (it’s a process for sure).

I wish you the best,

Marissa