Conventional ultrasound for diagnosis of hepatic steatosis is better than believed

Abstract

Background Hepatic steatosis is a condition frequently encountered in clinical practice, with potential progression towards fibrosis, cirrhosis, and hepatocellular carcinoma. Detection and staging of hepatic steatosis are of most importance in nonalcoholic fatty liver disease (NAFLD), a disease with a high prevalence of more than 1 billion individuals affected. Ultrasound (US) is one of the most used noninvasive imaging techniques used in the diagnosis of hepatic steatosis. Detection of hepatic steatosis with US relies on several conventional US parameters, which will be described. US is the first-choice imaging in adults at risk for hepatic steatosis. The use of some scoring systems may add additional accuracy especially in assessing the severity of hepatic steatosis.

Summary In the presented paper, we discuss screening and risk stratification, ultrasound features for diagnosing hepatic steatosis, B-mode criteria, focal fatty patterns and Doppler features of the hepatic vessels, and the value of the different US signs for the diagnosis of liver steatosis including classifying the severity of steatosis using different US scores. Limitations of conventional B-mode and Doppler features in the evaluation of hepatic steatosis are also discussed, including those in grading and assessing the complications of steatosis, namely fibrosis and nonalcoholic steatohepatitis.

Key Messages Ultrasound is the first-line imaging examination for the screening and follow-up of patients with liver steatosis. The use of some scoring systems may add additional accuracy in assessing the severity of steatosis. Conventional B-mode and Doppler ultrasound have limitations in grading and assessing the complications of steatosis.

Zusammenfassung

Hintergrund die Fettleber ist eine in der klinischen Praxis häufige Erkrankung mit dem Risiko ein Leberfibrose, Leberzirrhose und auch ein hepatozelluläres Karzinom (HCC) zu entwickeln. Die nicht-alkoholische Fettlebererkrankung (NAFLD) ist eine Krankheit mit hoher Prävalenz und mit mehr als einer Milliarde betroffener Personen. Der Nachweis und die Stadieneinteilung sind von prognostischer Bedeutung.

Ultraschall (US) ist eine weitverbreitete nichtinvasive Bildgebungstechnik, die auch bei der Diagnose der Fettleber eingesetzt werden kann. Der Nachweis einer Fettleber beruht zunächst auf anamnestischen Angaben und konventionellen sonografischen Zeichen. Die Verwendung von Bewertungssystemen kann die diagnostische Genauigkeit erhöhen, insbesondere bei der Beurteilung des Schweregrads.

In dem vorgestellten Artikel diskutieren wir Screening und auch die Risikostratifizierung für die Entwicklung einer Steatohepatitis, Leberfibrose und eines HCC. Die Ultraschallmerkmale zur Diagnose und Differenzialdiagnose der Fettleber inklusive von B-Mode-Kriterien und Doppler-Charakteristika von Lebergefäßen werden erläutert. Die Klassifizierung des Schweregrads der Steatose wird anhand von US-Scores beschrieben und deren Einschränkungen diskutiert.

Kernbotschaft Ultraschall ist die erste bildgebende Untersuchungstechnik für das Screening und Follow-up von Patienten mit Fettleber. Die Verwendung von Bewertungssystemen kann die Diagnostik verbessern.

Schlüsselwörter

Fettleber - nicht-alkoholische Fettlebererkrankung - Fibrose - Zirrhose - Ultraschall

Keywords

hepatic steatosis - nonalcoholic fatty liver disease - fibrosis - cirrhosis - conventional ultrasound

Publication History

Article published online:
25 June 2021

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