ACR Appropriateness Criteria® Chronic Liver Disease
ACR Appropriateness Criteria® Chronic Liver Disease
复制标题
DOI：
10.1016/j.jacr.2020.01.023
复制
发表时间：
2020-05-01
影响因子：
4.5
通讯作者：
Carucci, Laura R.
中科院分区：
文献类型：
--
作者：
Bashir, Mustafa R.;Horowitz, Jeanne M.;Carucci, Laura R.
肝纤维化分期是慢性肝病患者发病率和死亡率最重要的临床决定因素。随着新疗法的出现，肝纤维化可以稳定并可能逆转，因此肝纤维化的准确诊断和分期在临床上具有重要意义。超声、CT和常规MRI可用于晚期纤维化/肝硬化的诊断，但用于评估早期纤维化的效用有限。基于弹性成像的超声和MRI技术对肝硬化前肝纤维化的评估更有用。对于有肝细胞癌（HCC）风险的晚期纤维化患者，超声是国际指南在几乎所有情况下推荐的监测方式。然而，在超声不能很好地评估肝脏的患者中，包括那些严重脂肪变性或肥胖的患者，多期CT或MRI可能在HCC监测中发挥作用。对于有HCC病史的患者，多期CT和MRI均可用于持续监测，超声造影可能在此背景下发挥新的作用。美国放射学会适当性标准是针对特定临床条件的循证指南，每年由多学科专家小组审查。指南的制定和修订包括对来自同行评议期刊的当前医学文献的广泛分析，以及应用成熟的方法（RAND/UCLA适当性方法和建议评估、发展和评价分级或GRADE）来评估特定临床情况下成像和治疗程序的适当性。在证据缺乏或模棱两可的情况下，专家意见可能会补充现有证据，以推荐成像或治疗。
The liver fibrosis stage is the most important clinical determinate of morbidity and mortality in patients with chronic liver diseases. With newer therapies, liver fibrosis can be stabilized and possibly reversed, thus accurate diagnosis and staging of liver fibrosis are clinically important. Ultrasound, CT, and conventional MRI can be used to establish the diagnosis of advanced fibrosis/cirrhosis but have limited utility for assessing earlier stages of fibrosis. Elastography-based ultrasound and MRI techniques are more useful for assessment of precirrhotic hepatic fibrosis. In patients with advanced fibrosis at risk for hepatocellular carcinoma (HCC), ultrasound is the surveillance modality recommended by international guidelines in nearly all circumstances. However, in patients in whom ultrasound does not assess the liver well, including those with severe steatosis or obesity, multiphase CT or MRI may have a role in surveillance for HCC. Both multiphase CT and MRI can be used for continued surveillance in patients with a history of HCC, and contrast-enhanced ultrasound may have an emerging role in this setting.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.