Role of Ultrasound Methods for the Assessment of NAFLD

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. The prevalence in patients with type 2 diabetes mellitus is between 55-80%. The spectrum of NALFD ranges from simple steatosis to aggressive steatohepatitis with potentially progressive liver fibrosis up to cirrhosis and hepatocellular carcinoma. In clinical practice, there are two important aims: First to make the diagnosis of NAFLD, and second, to identify patients with advanced fibrosis, because extent of fibrosis is strongly associated with overall mortality, cardiovascular disease, hepatocellular carcinoma, and extrahepatic malignancy. Histology by liver biopsy can deliver this information, but it is an invasive procedure with rare, but potentially severe, complications. Therefore, non-invasive techniques were developed to stage fibrosis. Ultrasound is the primary imaging modality in the assessment of patients with confirmed or suspected NAFLD. This narrative review focus on different ultrasound methods to detect and graduate hepatic steatosis and to determine grade of fibrosis using elastography-methods, such as transient elastography and 2-dimensional shear wave elastography in patients with NAFLD. Particular attention is paid to the application and limitations in overweight patients in clinical practice. Finally, the role of B-mode ultrasound in NAFLD patients to screen for hepatocellular carcinoma is outlined.

Automated summary

Nonalcoholic fatty liver disease (NAFLD) is a prevalent liver disease worldwide, especially among patients with type 2 diabetes mellitus. The diagnosis of NAFLD and identification of advanced fibrosis are important aims in clinical practice. Liver biopsy can provide this information but is invasive and has potential complications. Non-invasive techniques, such as ultrasound, have been developed to stage fibrosis. This review focuses on various ultrasound methods and elastography techniques for detecting and grading hepatic steatosis and fibrosis in NAFLD patients, with attention given to the application and limitations in overweight patients. The role of B-mode ultrasound in screening for hepatocellular carcinoma in NAFLD patients is also outlined.