Diagnostic Value of Ultrasound in Fatty Liver Disease

Abstract

Hepatic steatosis is a commonly seen phenomenon in clinical practice and is the result of the accumulation of lipids in the hepatocytes. In most cases steatosis refers to nonalcoholic fatty liver disease (NAFLD), but it also occurs in other diseases of the liver parenchyma of a different etiology and is the result of the dysregulation of metabolic processes. Consequently, inflammatory processes can induce progressive fibrosis. Due to the high prevalence of fatty liver disease, a further increase in metabolic liver cirrhosis with corresponding complications can be expected in the near future. Due to its broad availability, ultrasound is particularly important, especially for the management of NAFLD. In addition to diagnosis and risk stratification, the monitoring of high-risk patients in NAFLD is becoming increasingly clinically important. Multimodality ultrasound includes B-mode and duplex methods, analysis of tissue stiffness (elastography), contrast-enhanced imaging (CEUS), and steatosis quantification. When using ultrasound in fatty liver disease, a standardized approach that takes into account the limitations of the method is essential.

Zusammenfassung

Die Leberzellverfettung ist ein in der klinischen Praxis häufig beobachtetes Phänomen und entsteht durch Einlagerung von Lipiden in die Hepatozyten. Die Steatose definiert in den meisten Fällen die nichtalkoholische Fettlebererkrankung (NAFLD), tritt aber auch bei anderen Leberparenchymerkrankungen unterschiedlicher Ätiologie auf und ist Ausdruck der Dysregulation metabolischer Prozesse. In der Folge können inflammatorische Prozesse eine fortschreitende Fibrose induzieren. Aufgrund der hohen Prävalenz von Fettlebererkrankungen muss in naher Zukunft mit einem weiteren Anstieg der metabolisch bedingten Leberzirrhose mit entsprechenden Folgekomplikationen gerechnet werden. Insbesondere für das Management der NAFLD ist die Ultraschalldiagnostik aufgrund der breiten Verfügbarkeit von besonderer Bedeutung. Neben Diagnosestellung und Risikostratifizierung hat die Überwachung von Risikopatienten bei NAFLD einen zunehmenden klinischen Stellenwert. Die multimodale Ultraschalldiagnostik umfasst dabei neben B-Bild- und Duplexverfahren die Analyse der Gewebesteifigkeit (Elastografie) und wird durch kontrastverstärkte Bildgebung (CEUS) und Steatosequantifizierung komplettiert. Für die Anwendung des Ultraschalls bei Fettlebererkrankungen ist ein standardisiertes Vorgehen unter Berücksichtigung der Methodenlimitationen unerlässlich.

Publikationsverlauf

Artikel online veröffentlicht:
23. Februar 2021

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