Abstract
Simple SummaryNon-alcoholic fatty liver disease (NAFLD) attracts a lot of attention, due to the increasing prevalence and progression to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Consequently, new non-invasive, cost-effective diagnostic methods are needed. This review aims to explore the diagnostic performance of ultrasound (US) elastography in NAFLD and NAFLD-related HCC, adding a new dimension to the conventional US examination—the liver stiffness quantification. The vibration controlled transient elastography (VCTE), and 2D-Shear wave elastography (2D-SWE) are effective in staging liver fibrosis in NAFLD. VCTE presents the upside of assessing steatosis through the controlled attenuation parameter. Hereby, we critically reviewed the elastography techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography and 2D-SWE. 2D-SWE presents a great potential to differentiate malignant from benign FLLs, guiding the clinician towards the next diagnostic steps. As a disease-specific surveillance tool, US elastography presents prognostic capability, improving the NAFLD-related HCC monitoring.The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population prompts for a quick response from physicians. As NAFLD can progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), new non-invasive, rapid, cost-effective diagnostic methods are needed. In this review, we explore the diagnostic performance of ultrasound elastography for non-invasive assessment of NAFLD and NAFLD-related HCC. Elastography provides a new dimension to the conventional ultrasound examination, by adding the liver stiffness quantification in the diagnostic algorithm. Whilst the most efficient elastographic techniques in staging liver fibrosis in NAFLD are vibration controlled transient elastography (VCTE) and 2D-Shear wave elastography (2D-SWE), VCTE presents the upside of assessing steatosis through the controlled attenuation parameter (CAP). Hereby, we have also critically reviewed the most important elastographic techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography (pSWE) and 2D-SWE. As our paper shows, elastography should not be considered as a substitute for FLL biopsy because of the stiffness values overlap. Furthermore, by using non-invasive, disease-specific surveillance tools, such as US elastography, a subset of the non-cirrhotic NAFLD patients at risk for developing HCC can be detected early, leading to a better outcome. A recent ultrasomics study exemplified the wide potential of 2D-SWE to differentiate benign FLLs from malignant ones, guiding the clinician towards the next steps of diagnosis and contributing to better long-term disease surveillance.
Highlights
Non-alcoholic fatty liver disease (NAFLD) has become a major public health issue, with a current global prevalence estimated at around 25%, and a tendency of rapidly growing [1]
The spectrum of NAFLD varies from simple steatosis to non-alcoholic steatohepatitis (NASH), but further progression can lead to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC)
Less expensive [66], point-of-care examination; Easy to perform by non-specialized personnel after appropriate training [67]; Good reproducibility; The quality criteria are well-defined; Good diagnostic accuracy for the stages of fibrosis in the liver; Can assess steatosis using the Controlled attenuation parameter (CAP); More research work was involved for vibration controlled transient elastography (VCTE) in NAFLD patients, compared to the alternatives
Summary
Non-alcoholic fatty liver disease (NAFLD) has become a major public health issue, with a current global prevalence estimated at around 25%, and a tendency of rapidly growing [1]. The etiologies for HCC in liver transplant candidates showed a shift during the last years, with a decrease of hepatitis C virus (HCV) and alcohol etiologies and a higher percentage of NAFLD-related HCC [3,4] This trend highlights the increasing importance of detecting early developing HCC in NAFLD patients through rapid, non-invasive means. The imaging diagnostic criteria for HCC detection on CT and MRI should be used with great carefulness in patients with underlying NASH, since 40% of HCC nodules do not display wash-out on the portal or delayed phase images on MRI; encapsulation was identified only in 60% of HCC nodules, leading to difficult interpretation [9,10] These patients are more likely to require a liver biopsy, which is able to confirm de HCC and characterize the status of the liver parenchyma affected by NAFLD [11]. This review aims to highlight the role of ultrasound elastographic techniques to assess both the focal liver lesions (FLLs) and the liver parenchyma status on which the FLL has developed
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