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Diagnostic challenges of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis
Erin Cleveland M.D.
Andrew Bandy M.D.
Lisa B. VanWagner M.D., M.Sc.
First published: 20 April 2018
https://doi.org/10.1002/cld.716
This study was supported by the National Institutes of Health, National Heart, Lung and Blood Institute (grant K23HL136891 to L.B.V.W.).
Potential conflict of interest: Nothing to report.
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Abbreviations
AASLD
American Association for the Study of Liver Diseases
ALT
alanine aminotransferase
APRI
AST‐to‐platelet ratio index
ARFI
acoustic radiation force impulse
AST
aspartate aminotransferase
BARD
BMI, AST:ALT ratio, and diabetes status score
BMI
body mass index
CAP
controlled attenuation parameter
CK‐18
cytokeratin‐18
CT
computed tomography
EASL
European Association for the Study of the Liver
EASO
European Association for the Study of Obesity
ELF
enhanced liver fibrosis
FIB‐4
Fibrosis‐4
GGT
gamma‐glutamyltransferase
HAIR
hypertension, age, insulin resistance
MR
magnetic resonance
MRE
magnetic resonance elastography
MRI‐PDFF
magnetic resonance‐proton density fat fraction
NAFL
nonalcoholic fatty liver
NAFLD
nonalcoholic fatty liver disease
NASH
nonalcoholic steatohepatitis
NPV
negative predictive value
PPV
positive predictive value
TE
transient elastography
VCTE
vibration‐controlled transient elastography
Nonalcoholic fatty liver disease (NAFLD) is a global epidemic that ranges from isolated hepatic steatosis (nonalcoholic fatty liver [NAFL]) to steatosis plus inflammation (nonalcoholic steatohepatitis [NASH]) with or without fibrosis (Fig. 1).1 Whereas NAFL generally follows a benign course, NASH carries a significant risk for progression to fibrosis.2 The key diagnostic challenges in NAFLD are to accurately detect NASH and to quantify the degree of fibrosis to identify those at highest risk for liver‐related morbidity and mortality. Thus, when seeing a patient with possible NAFLD, the primary questions to answer are: (1) Does this patient have NAFLD? (2) Does this patient have underlying NASH? (3) Does this patient have any fibrosis? and (4) Does this patient have advanced fibrosis (stage 3 or 4)?
Figure 1
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Serum biomarkers and imaging modalities across the NAFLD spectrum.
Abbreviations: APRI, AST‐to‐platelet ratio index; ARFI, acoustic radiation force impulse; BARD, BMI, AST:ALT ratio, and diabetes status score; CK‐18, cytokeratin‐18; HAIR, hypertension, age, insulin resistance.
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发表于 2018-8-21 18:34