Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan.
Department of Gastroenterology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
J Med Ultrason (2001). 2020 Oct;47(4):511-520. doi: 10.1007/s10396-020-01058-y. Epub 2020 Oct 21.
Nonalcoholic fatty liver disease (NAFLD) is entering a new era in terms of diagnosis and conceptualization. The term NAFLD is considered to not reflect current knowledge. Metabolic dysfunction-associated fatty liver disease (MAFLD) has been suggested as a more appropriate overarching term by experts in this field. Regarding NAFLD progression, most patients die from non-liver-related diseases, even patients with advanced fibrosis. Liver biopsy is essential for the diagnosis of nonalcoholic steatohepatitis (NASH); it is the only procedure that reliably differentiates NAFLD from NASH. Recently, various noninvasive methods for diagnosing steatosis and fibrosis have been developed. Ultrasound attenuation measurements and proton density fat fraction with magnetic resonance imaging (MRI) have been developed as imaging tools for predicting steatosis. Fibrosis-4 index and NAFLD fibrosis score are complex scores for predicting fibrosis in patients with NAFLD. In addition, elastography based on ultrasound and MRI has been developed as an imaging tool for predicting fibrosis. There is a strong correlation between values from various real-time shear wave elastography devices and transient elastography, which is the gold standard for ultrasound-based measurements of liver stiffness. In conclusion, NAFLD is at a turning point in terms of its conceptualization, terminology, and diagnostics. It is now time to reconfirm the role of ultrasonography for the assessment of NAFLD.
非酒精性脂肪性肝病（NAFLD）在诊断和概念上正进入一个新时代。NAFLD 这一术语被认为不能反映当前的知识。该领域的专家建议使用代谢功能相关脂肪性肝病（MAFLD）作为更合适的概括性术语。关于 NAFLD 的进展，大多数患者死于非肝脏相关疾病，即使是有晚期纤维化的患者。肝活检对于非酒精性脂肪性肝炎（NASH）的诊断至关重要；它是唯一可靠地区分 NAFLD 和 NASH 的程序。最近，已经开发出了各种用于诊断脂肪变性和纤维化的非侵入性方法。超声衰减测量和磁共振成像（MRI）的质子密度脂肪分数已被开发为预测脂肪变性的影像学工具。纤维化 4 指数和非酒精性脂肪性肝病纤维化评分是预测非酒精性脂肪性肝病患者纤维化的复杂评分。此外，基于超声和 MRI 的弹性成像已被开发为预测纤维化的影像学工具。各种实时剪切波弹性成像设备与瞬时弹性成像之间存在很强的相关性，瞬时弹性成像是基于超声测量肝硬度的金标准。总之，NAFLD 在概念、术语和诊断方面正处于一个转折点。现在是时候重新确认超声在评估 NAFLD 中的作用了。
