Current status of imaging in nonalcoholic fatty liver disease (original) (raw)
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Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease
World journal of hepatology, 2015
Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease and is a major public health problem worldwide. It is a spectrum that includes simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Recently, NAFLD prevalence in children and adolescents has increased too. The increasing prevalence has resulted in NASH-related chronic liver disease. Therefore, early diagnosis and treatment is quite important. Although liver biopsy is still the gold standard for diagnosis and staging of NAFLD, particularly for the diagnosis of NASH, imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging with chemical shift imaging and especially magnetic resonance spectroscopy and elastography have been increasingly approved as noninvasive alternative methods. The aim of this review is to analyze the diagnostic accuracy and limitations of the imaging methods and recent developments in the diagnosis of NAFLD.
Expert review of clinical pharmacology, 2017
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and cirrhosis worldwide and the second most common cause of liver transplantation in major medical centers. Because liver steatosis and fibrosis severity are related to disease morbidity and mortality, the extent of disease, and disease progression, they need to be assessed and monitored. In addition, innovation with new drug developments requires disease staging and monitoring in both phase 2 and 3 clinical trials. Currently, disease assessment in both clinical practice and research is mostly performed by liver biopsy, an invasive, procedure with risks. Noninvasive, highly accurate tests are needed that could be used in clinical trials as surrogate endpoints and in clinical practice for monitoring patients. Area Covered: We discuss noninvasive tests, transient elastography (TE) with controlled attenuation parameter (CAP), magnetic resonance imaging (MRI), and MR elastography (MRE), summarize ...
International Journal of Medical Sciences, 2019
Introduction: Non-alcoholic fatty liver disease (NAFLD) may progress to steatohepatitis, cirrhosis and complicated hepatocellular carcinoma with defined differential symptoms and manifestations. Objective: To evaluate the fatty liver status by several validated approaches and to compare imaging techniques, lipidomic and routine blood markers with magnetic resonance imaging in adults subjects with non-alcoholic fatty liver disease. Materials and methods: A total of 127 overweight/obese with NAFLD, were parallelly assessed by Magnetic Resonance Imaging (MRI), ultrasonography, transient elastography and a validated metabolomic designed test to diagnose NAFLD in this cross-sectional study. Body composition (DXA), hepatic related biochemical measurements as well as the Fatty Liver Index (FLI) were evaluated. This study was registered as FLiO: Fatty Liver in Obesity study; NCT03183193. Results: The subjects with more severe liver disease were found to have worse metabolic parameters. Positive associations between MRI with inflammatory and insulin biomarkers were found. A linear regression model including ALT, RBP4 and HOMA-IR was able to explain 40.9% of the variability in fat content by MRI. In ROC analyses a combination panel formed of ALT, HOMA-IR and RBP4 followed by ultrasonography, ALT and metabolomic test showed the major predictive ability (77.3%, 74.6%, 74.3% and 71.1%, respectively) for liver fat content. Conclusions: A panel combination including routine blood markers linked to insulin resistance showed highest associations with MRI considered as a gold standard for determining liver fat content. This combination of tests can facilitate the diagnosis of early stages of non-alcoholic liver disease thereby avoiding other invasive and expensive methods.
Nonalcoholic fatty liver disease: Noninvasive methods of diagnosing hepatic steatosis
Hepatic steatosis is the buildup of lipids within hepatocytes. It is the simplest stage in nonalcoholic fatty liver disease (NAFLD). It occurs in approximately 30% of the general population and as much as 90% of the obese population in the United States. It may progress to nonalcoholic steatohepatitis, which is a state of hepatocellular inflammation and damage in response to the accumulated fat. Liver biopsy remains the gold standard tool to diagnose and stage NAFLD. However, it comes with the risk of complications ranging from simple pain to life‑threatening bleeding. It is also associated with sampling error. For these reasons, a variety of noninvasive radiological markers, including ultrasound, computed tomography, magnetic resonance spectroscopy, and the controlled attenuation parameter using transient elastography and Xenon‑133 scan have been proposed to increase our ability to diagnose NAFLD, hence avoiding liver biopsy. The aim of this review is to discuss the utility and accuracy of using available noninvasive diagnostic modalities for fatty liver in NAFLD.
Imaging biomarkers for steatohepatitis and fibrosis detection in non-alcoholic fatty liver disease
Scientific Reports, 2016
There is a need, in NAFLD management, to develop non-invasive methods to detect steatohepatitis (NASH) and to predict advanced fibrosis stages. We evaluated a tool based on optical analysis of liver magnetic resonance images (MRI) as biomarkers for NASH and fibrosis detection by investigating patients with biopsy-proven NAFLD who underwent magnetic resonance (MR) protocols using 1.5T General Electric (GE) or Philips devices. Two imaging biomarkers (NASHMRI and FibroMRI) were developed, standardised and validated using area under the receiver operating characteristic curve (AUROC) analysis. The results indicated NASHMRI diagnostic accuracy for steatohepatitis detection was 0.83 (95% CI: 0.73-0.93) and FibroMRI diagnostic accuracy for significant fibrosis determination was 0.85 (95% CI: 0.77-0.94). These findings were independent of the MR system used. We conclude that optical analysis of MRI has high potential to define non-invasive imaging biomarkers for the detection of steatohepatitis (NASHMRI) and the prediction of significant fibrosis (FibroMRI) in NAFLD patients. Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed when evidence of steatosis, obtained either by imaging or histology, is found in the absence of significant alcohol consumption, viral infection, and autoimmune or drug-related liver injury 1. About a third of the overall population currently suffer from any stage of NAFLD 2. NAFLD is a clinico-pathological entity that ranges from hepatic fat accumulation (simple steatosis) to non-alcoholic steatohepatitis (NASH), which is a progressive form that may lead to fibrosis 3 , cirrhosis and ultimately hepatocellular carcinoma 4,5. Furthermore, liver fibrosis is the strongest predictor to long-term overall mortality and liver-related events 6. Patients with NAFLD almost invariably display insulin resistance, together with other morbid-mortality risk factors such as overweight, visceral adiposity, diabetes, hyperlipidaemia and high blood pressure. These patients also show an augmented rate of mortality compared to general population paired by age and sex 7 .
Radiologic evaluation of nonalcoholic fatty liver Disease
Medical Journal of Viral Hepatitis
Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. NAFLD comprises a range of liver conditions varying in severity of hepatocytes injury and resulting fibrosis-cirrhosis risk. Among these, hepatic steatosis (fatty liver) is referred to as NAFL, and nonalcoholic fatty liver (NAFL) is defined as a more grave process with both fat and inflammation in the liver that over time can cause liver cirrhosis (steatohepatitis). Liver biopsy is the gold standard method to differentiate, whether the patient with fatty liver has only steatosis, or NASH. Unfortunately, liver biopsy has well-known limitations (invasiveness and sampling variability) and cannot be proposed for all patients, especially given the high prevalence of NAFLD worldwide. This review discuss the radiologic evaluation of liver steatosis and fibrosis for patients with NAFLD.
Ultrasound in Medicine & Biology, 2018
Non-alcoholic fatty liver disease (NAFLD) is a condition that is characterized by the presence of >5% fat in the liver and affects over one billion people worldwide. If adequate and early precautions are not taken, NAFLD can progress to cirrhosis and death. The current reference standard for detecting hepatic steatosis is a liver biopsy. However, due to the potential morbidity associated with liver biopsies, non-invasive imaging biomarkers have been extensively investigated. Magnetic resonance imaging (MRI)-based methods have proven accuracy in quantifying liver steatosis; however, these techniques are costly and have limited availability. Ultrasound-based quantitative imaging techniques are increasingly utilized because of their widespread availability, ease of use, and relative cost-effectiveness. Several ultrasound-based liver fat quantification techniques have been investigated, including techniques that measure changes in the acoustic properties of the liver due to the presence of fat. In this review, we will focus on quantitative ultrasound approaches and their diagnostic performance in the realm of NAFLD.
Non-invasive methods for the diagnosis of nonalcoholic fatty liver disease
World journal of hepatology, 2015
Nonalcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease and includes simple steatosis and nonalcoholic steatohepatitis (NASH). Since NASH progresses to cirrhosis more frequently and increases liver-related and cardiovascular disease risk substantially more than simple steatosis, there is a great need to differentiate the two entities. Liver biopsy is the gold standard for the diagnosis of NAFLD but its disadvantages, including the risk of complications and sampling bias, stress the need for developing alternative diagnostic methods. Accordingly, several non-invasive markers have been evaluated for the diagnosis of simple steatosis and NASH, including both serological indices and imaging methods. The present review summarizes the current knowledge on the role of these markers in the diagnosis of NAFLD. Current data suggest that ultrasound and the fibrosis-4 score are probably the most appealing methods for detecting steatosis and for distinguishing NASH from s...