What other than biopsy to detect nash or nafld if ultrasound was negative and alt was average 120 for more than 7 months.fully neg workup 24y m.bmi 20?

ALT and HCV: Ultrasound when performed properly is an excellent test for both nafld and/or nash. You do not have the characteristic risk factors for fatty liver, although I have observed it in normal weight vegetarians. You state that a previous work-up was negative. I would want to know specifically if you were tested for viral hepatitis, especially hepatitis c. Ask for hcv RNA pcr.

MRI: Another noninvasive test would be MRI with in and out of phase imaging.