Magnetic resonance imaging for the assessment of pathological hepatic findings in nonalcoholic fatty liver disease
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SPECIAL FEATURE: REVIEW ARTICLE Diagnosis and assessment of nonalcoholic fatty liver disease / nonalcoholic steatohepatitis using ultrasound elastography
Magnetic resonance imaging for the assessment of pathological hepatic findings in nonalcoholic fatty liver disease Kento Imajo1 · Yasushi Honda1 · Masato Yoneda1 · Satoru Saito1 · Atsushi Nakajima1 Received: 18 August 2020 / Accepted: 25 September 2020 © The Japan Society of Ultrasonics in Medicine 2020
Abstract The prevalence of nonalcoholic fatty liver disease (NAFLD) is expected to increase because of the current epidemics of obesity and diabetes, and NAFLD has become a major cause of chronic liver disease worldwide. Liver fibrosis is associated with poor long-term outcomes in patients with NAFLD. Additionally, increased mortality and liver-related complications are primarily seen in patients with nonalcoholic steatohepatitis (NASH); however, nonalcoholic fatty liver (NAFL) is believed to be benign and non-progressive. Therefore, distinguishing between NASH and NAFL is clinically important. Liver biopsy is the gold standard method for the staging of liver fibrosis and distinguishing between NASH and NAFL. Unfortunately, liver biopsy is an invasive and expensive procedure. Therefore, noninvasive methods, to replace biopsy, are urgently needed for the staging of liver fibrosis and diagnosing NASH. In this review, we discuss the recent studies on magnetic resonance imaging (MRI), including magnetic resonance elastography, proton density fat fraction measurement, and multiparametric MRI (mpMRI) that can be used in the assessment of NASH components such as liver fibrosis, steatosis, and liver injury including inflammation and ballooning. Keywords Magnetic resonance elastography · Proton density fat fraction · Corrected-T1 · Nonalcoholic fatty liver disease · Nonalcoholic steatohepatitis
Introduction Nonalcoholic fatty liver disease (NAFLD) has become a major cause of chronic liver disease worldwide. Its prevalence is currently estimated to be 25% in the general population [1, 2], 90% in those with obesity, and 60% in those with type 2 diabetes mellitus [3–5]. The prevalence of NAFLD is expected to increase because of the current epidemics of obesity and diabetes [6]. Additionally, liver fibrosis has been reported to be strongly associated with the long-term outcomes in patients with NAFLD [7, 8]. Liver biopsy is the recommended gold standard method in the diagnosis of nonalcoholic steatohepatitis (NASH) and staging of liver fibrosis in patients with NAFLD [9]. * Atsushi Nakajima nakajima‑[email protected] 1
Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236‑0004, Japan
However, because of high costs, possible risks, and requirement for healthcare resources, an invasive liver biopsy is a poorly suited diagnostic test for such a prevalent condition [10]. Therefore, alternatives to liver biopsy, including biochemical tests and assessments of liver stiffness measurement (LSM), are being developed [11]
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