For 2 negative ultrasound in chronic elevated liver enzymes, and running away from biopsy, can an mri help and does it need contrast? r/o nash nafld?

Need biopsy: If your enzymes have been elevated for a long period of time, the only definitive test is a liver biopsy, performed either under ultrasound or ct. It is a relatively painless procedure, done as an outpatient, usually with local anesthetic. You should be able to go home within 2 hours. Bleeding is a potential complication, but usually self-limited if you have normal clotting. Treatment follows dx.

CT may help: Ct is commonly done with contrast which is safe. This may reveal an answer or target an area that would need a biopsy. There are many causes for elevated liver enzymes that may not be determined from an anatomical test.