超声在肝脏脂肪变性中的应用评价

StephenW

A critical appraisal of the use of ultrasound in hepatic steatosis
Stefano Ballestri, Fabio Nascimbeni, Simonetta Lugari, Amedeo Lonardo & Giampiero Francica
Pages 667-681 | Received 05 Feb 2019, Accepted 16 May 2019, Accepted author version posted online: 18 May 2019, Published online: 29 May 2019

    Download citation https://doi.org/10.1080/17474124.2019.1621164

ABSTRACT

Introduction: Nonalcoholic fatty liver disease (NAFLD) spans steatosis through nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). NAFLD carries an increased risk of cardio-metabolic and liver-related events accounting for a substantial economic burden. Given that the natural history of NAFLD is critically dependent on the stage of fibrosis, non-invasively identifying the subgroup of patients at a higher risk of progressive disease is key.

Areas covered: This review highlights the recent developments in the use of ultrasound-based techniques in NAFLD and their performance in predicting metabolic derangements, cardiovascular risk, and progression of liver disease, notably including diagnosis of fibrosing NASH, identification, and treatment of HCC.

Expert opinion: Our ability to identify NAFLD patients and to estimate steatofibrosis with various ultrasound-based techniques has undergone tremendous progress over the last few years. However, it is more difficult to capture the inflammatory component of NASH with such ultrasound-assisted techniques. Moreover, semi-quantitative, quantitative, elastographic, and contrast-enhanced ultrasound techniques are increasingly being appreciated and made available but not all such techniques will gain success in the clinical and research area. Therefore, further research will precisely define the role of the most innovative ultrasonographic techniques, while reducing costs and increasing feasibility.
KEYWORDS: Cardio-metabolic risk, contrast-enhanced ultrasonography, controlled attenuation parameter, hepatic fibrosis/cirrhosis, hepatocellular carcinoma, liver stiffness measurement, metabolic derangements, NAFLD/NASH, portal hypertension, shear wave elastography
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Article highlights

    Ultrasound-based techniques have dramatically improved our capacity to non-invasively identify NAFLD patients and precisely assess steatosis.

    The inflammatory-fibrotic component of NAFLD/NASH, however, is the least susceptible to be captured with such techniques.

    Further research remains to be done, therefore, to precisely ascertain the role, if any, of more recent technical advancements, reduce costs, and increase their feasibility.

    Conventional B-mode ultrasonographic imaging maintains a key role in the surveillance aimed at an early diagnosis of HCC.

    CEUS is a promising tool in assisting loco-regional ablative maneuvers which would be difficult to perform with conventional B-mode ultrasonography.

StephenW

超声在肝脏脂肪变性中的应用评价
Stefano Ballestri，Fabio Nascimbeni，Simonetta Lugari，Amedeo Lonardo和Giampiero Francica
第667-681页|收到2019年2月5日，接受2019年5月16日，接受作者版本在线发布：2015年5月18日，在线发布：2019年5月29日

下载引文https://doi.org/10.1080/17474124.2019.1621164

抽象

简介：非酒精性脂肪性肝病（NAFLD）通过非酒精性脂肪性肝炎（NASH），纤维化，肝硬化和肝细胞癌（HCC）跨越脂肪变性。 NAFLD增加了心脏代谢和肝脏相关事件的风险，导致更大的经济负担。鉴于NAFLD的自然病史严重依赖于纤维化的阶段，因此非侵入性地识别具有较高进展性疾病风险的患者亚组是关键。

涵盖的领域：本综述重点介绍了NAFLD中使用超声技术的最新进展及其在预测代谢紊乱，心血管风险和肝病进展方面的表现，尤其包括纤维化NASH的诊断，鉴别和HCC治疗。

专家意见：我们通过各种超声技术识别NAFLD患者和估计脂肪纤维化的能力在过去几年中取得了巨大进步。然而，用这种超声辅助技术捕获NASH的炎性成分更加困难。 ，半定量，定量，弹性成像和对比增强超声技术越来越受到重视和提供，但并非所有这些技术都会在临床和研究领域取得成功。进一步的研究将准确定义最具创新性的超声波检查的作用技术，同时降低成本和增加可行性。
关键词：心脏代谢风险，对比增强超声，控制衰减参数，肝纤维化/肝硬化，肝细胞癌，肝硬度测量，代谢紊乱，NAFLD / NASH，门静脉高压，剪切波弹性成像
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文章重点

基于超声波的技术极大地提高了我们非侵入性地识别NAFLD患者和定时评估脂肪变性的能力。

然而，NAFLD / NASH的炎性纤维化成分最不易被这些技术捕获。

因此，还需要进一步研究，以便更好地确定最近技术进步的作用，降低成本并提高其可行性。

传统的B型超声成像在早期诊断HCC时的监测中起着关键作用。

CEUS是一种很有前途的辅助局部区域消融操作的工具，传统的B型超声检查难以完成。