Department of Gastroenterology and Hepatology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawaku, 3-9 Fukuura, Kanazawaku, Yokohama, 236-0004, Japan.
J Med Ultrason (2001). 2020 Oct;47(4):521-533. doi: 10.1007/s10396-020-01040-8. Epub 2020 Aug 3.
The prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) has increased rapidly worldwide, making NAFLD/NASH an important global health problem from both a medical and socioeconomic standpoint. NAFLD is also regarded as a liver component of metabolic syndrome and is reported to be associated with the risk factors for metabolic syndrome. It has been suggested that NAFLD/NASH be recognized both as a liver-specific disease and as an early mediator of systemic diseases. Liver biopsy is recommended as the gold standard method for the diagnosis of NASH and for the staging of liver fibrosis in patients with NAFLD. However, because of its high cost, high risk, and high weightage as a healthcare resource, invasive liver biopsy is a poorly suited diagnostic test for such a highly prevalent condition. Therefore, the development of reliable noninvasive methods for the assessment of liver fibrosis has been sought to estimate the risk of progression of NASH to cirrhosis, estimate the risk of cardiovascular events, aid in the surveillance for HCC, and guide therapy in patients with NAFLD/NASH. In this review, we highlight the principles and recent advances in ultrasound elastography techniques (Real-time Tissue Elastography, vibration-controlled transient elastography, point shear wave elastography, and two-dimensional shear wave elastography) used to evaluate the liver fibrosis stage and steatosis grade in patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的患病率在全球范围内迅速增加，使得 NAFLD/NASH 成为一个从医学和社会经济学角度来看都非常重要的全球性健康问题。NAFLD 也被认为是代谢综合征的肝脏组成部分，并且与代谢综合征的危险因素有关。有人认为，NAFLD/NASH 既是一种肝脏特异性疾病，也是全身性疾病的早期介导因素。肝活检被推荐为 NASH 的诊断和 NAFLD 患者肝纤维化分期的金标准方法。然而，由于其成本高、风险高，并且在医疗保健资源方面的权重较大，因此，侵入性肝活检并不适合用于诊断这种高度流行的疾病。因此，人们一直在寻求可靠的非侵入性方法来评估肝纤维化，以估计 NASH 向肝硬化进展的风险、估计心血管事件的风险、有助于 HCC 的监测，并指导 NAFLD/NASH 患者的治疗。在这篇综述中，我们重点介绍了用于评估 NAFLD 患者肝纤维化分期和脂肪变性程度的超声弹性成像技术（实时组织弹性成像、振动控制瞬态弹性成像、点剪切波弹性成像和二维剪切波弹性成像）的原理和最新进展。
