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An important contribution of the study is their result showing failure of the Swansea criteria to differentiate between acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes, and low platelets (HELLP) and other causes of acute liver failure (ALF). AFLP is a histological diagnosis, and advanced imaging techniques such as proton density fat fraction (PDFF) estimation by magnetic resonance imaging (MRI)(2) may be used as surrogate markers in the diagnosis or progression/regression of disease. Because the Swansea criteria include soft clinical and laboratory criteria, it is not surprising that all three groups in the Casey et al. series could easily garner > 6 points, making efforts at separating AFLP from HELLP redundant. Although the results are well presented, a few points require clarification or discussion.