Radiologic evaluation of nonalcoholic fatty liver disease
Radiologic evaluation of nonalcoholic fatty liver disease
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DOI：
10.3748/wjg.v20.i23.7392
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发表时间：
2014-06-21
影响因子：
4.3
通讯作者：
Park, Seong Ho
中科院分区：
文献类型：
--
作者：
Lee, Seung Soo;Park, Seong Ho
非酒精性脂肪性肝病（NAFLD）是慢性肝病的常见原因，从单纯性脂肪变性到非酒精性脂肪性肝炎（NASH）相关的肝硬化。虽然肝活检仍然是诊断NAFLD的金标准，特别是对于NASH的诊断，但成像方法已越来越多地被接受为肝活检的非侵入性替代方法。超声检查是一种成熟且具有成本效益的诊断肝脂肪变性的成像技术，特别是用于筛查有NAFLD风险的大量人群。超声检查在检测中重度肝脂肪变性方面具有合理的准确性，尽管其检测轻度肝脂肪变性的准确性较低，依赖于操作者，并且相当定性。由于计算机断层扫描在检测轻度肝脂肪变性和潜在辐射危害方面的不准确性，因此不适用于一般人群的肝脂肪变性评估。然而，计算机断层扫描可能是有效的，在特定的临床情况下，如评估供体候选人的肝移植。磁共振波谱和磁共振成像现在被认为是临床实践中测量肝脏脂肪的最准确实用的方法，特别是对于NAFLD患者的纵向随访。超声弹性成像和磁共振弹性成像越来越多地用于评估NAFLD患者的肝纤维化程度，并将NASH与单纯性脂肪变性区分开来。本文将回顾目前用于评估肝脂肪变性的影像学方法，包括每种方法的诊断准确性，局限性和实用性。它还将简要描述弹性成像技术在评估NAFLD患者中的潜在作用。(C)2014百世登出版集团股份有限公司All rights reserved.
Nonalcoholic fatty liver disease (NAFLD) is a frequent cause of chronic liver diseases, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH)-related liver cirrhosis. Although liver biopsy is still the gold standard for the diagnosis of NAFLD, especially for the diagnosis of NASH, imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy. Ultrasonography is a well-established and cost-effective imaging technique for the diagnosis of hepatic steatosis, especially for screening a large population at risk of NAFLD. Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis, operator-dependent, and rather qualitative. Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard. However, computed tomography may be effective in specific clinical situations, such as evaluation of donor candidates for hepatic transplantation. Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice, especially for longitudinal follow-up of patients with NAFLD. Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis. This article will review current imaging methods used to evaluate hepatic steatosis, including the diagnostic accuracy, limitations, and practical applicability of each method. It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.