弹性成像技术在非酒精性脂肪性肝病肝纤维化无创诊断中的应用进展
DOI: 10.3969/j.issn.1001-5256.2023.02.025
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:陈立负责酝酿、设计和指导研究;陆梦负责文献搜集和起草文章;王铭杰、陈立获取研究经费及对文章知识性内容作批评性审阅。
Advances in the application of elastography in noninvasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease
-
摘要: 非酒精性脂肪性肝病(NAFLD)已成为最常见的慢性肝病,肝纤维化与NAFLD的预后密切相关,精准评估肝纤维化至关重要。NAFLD诊断的金标准是肝穿刺活检,然而其有创性限制了临床应用。基于超声和磁共振的弹性成像技术逐渐应用于NAFLD相关纤维化诊断中,本文主要介绍两项技术的原理,比较各自优缺点以及结合人工智能技术的应用进展。Abstract: Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease, and liver fibrosis is closely associated with the prognosis in NAFLD; therefore, accurate assessment of liver fibrosis is of great importance. Liver biopsy is the gold standard for the diagnosis of NAFLD, but its clinical application is limited by invasiveness. Elastography technique based on ultrasound and magnetic resonance imaging has gradually been applied in the diagnosis of liver fibrosis associated with NAFLD. This article elaborates on the principles of the two techniques, compares their respective advantages and disadvantages, and introduces the advances in application in combination with artificial intelligence.
-
[1] YOUNOSSI ZM, KOENIG AB, ABDELATIF D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64(1): 73-84. DOI: 10.1002/hep.28431. [2] CHALASANI N, YOUNOSSI Z, LAVINE JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases[J]. Hepatology, 2018, 67(1): 328-357. DOI: 10.1002/hep.29367. [3] TARGHER G, TILG H, BYRNE CD. Non-alcoholic fatty liver disease: a multisystem disease requiring a multidisciplinary and holistic approach[J]. Lancet Gastroenterol Hepatol, 2021, 6(7): 578-588. DOI: 10.1016/S2468-1253(21)00020-0. [4] SIDDIQUI MS, VUPPALANCHI R, van NATTA ML, et al. Vibration-controlled transient elastography to assess fibrosis and steatosis in patients with nonalcoholic fatty liver disease[J]. Clin Gastroenterol Hepatol, 2019, 17(1): 156-163. e2. DOI: 10.1016/j.cgh.2018.04.043. [5] EDDOWES PJ, SASSO M, ALLISON M, et al. Accuracy of fibroscan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease[J]. Gastroenterology, 2019, 156(6): 1717-1730. DOI: 10.1053/j.gastro.2019.01.042. [6] BOURSIER J, HAGSTRÖM H, EKSTEDT M, et al. Non-invasive tests accurately stratify patients with NAFLD based on their risk of liver-related events[J]. J Hepatol, 2022, 76(5): 1013-1020. DOI: 10.1016/j.jhep.2021.12.031. [7] KENNEDY P, WAGNER M, CASTÉRA L, et al. Quantitative elastography methods in liver disease: current evidence and future directions[J]. Radiology, 2018, 286(3): 738-763. DOI: 10.1148/radiol.2018170601. [8] PETTA S, WAI-SUN WONG V, BUGIANESI E, et al. Impact of obesity and alanine aminotransferase levels on the diagnostic accuracy for advanced liver fibrosis of noninvasive tools in patients with nonalcoholic fatty liver disease[J]. Am J Gastroenterol, 2019, 114(6): 916-928. DOI: 10.14309/ajg.0000000000000153. [9] WONG VW, IRLES M, WONG GL, et al. Unified interpretation of liver stiffness measurement by M and XL probes in non-alcoholic fatty liver disease[J]. Gut, 2019, 68(11): 2057-2064. DOI: 10.1136/gutjnl-2018-317334. [10] MÓZES FE, LEE JA, SELVARAJ EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis[J]. Gut, 2022, 71(5): 1006-1019. DOI: 10.1136/gutjnl-2021-324243. [11] TAPPER EB, LOOMBA R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(5): 274-282. DOI: 10.1038/nrgastro.2018.10. [12] LOOMBA R, WOLFSON T, ANG B, et al. Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study[J]. Hepatology, 2014, 60(6): 1920-1928. DOI: 10.1002/hep.27362. [13] ALLEN AM, SHAH VH, THERNEAU TM, et al. The role of three-dimensional magnetic resonance elastography in the diagnosis of nonalcoholic steatohepatitis in obese patients undergoing bariatric surgery[J]. Hepatology, 2020, 71(2): 510-521. DOI: 10.1002/hep.30483. [14] JAYAKUMAR S, MIDDLETON MS, LAWITZ EJ, et al. Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: Analysis of data from a phase Ⅱ trial of selonsertib[J]. J Hepatol, 2019, 70(1): 133-141. DOI: 10.1016/j.jhep.2018.09.024. [15] AJMERA VH, LIU A, SINGH S, et al. Clinical utility of an increase in magnetic resonance elastography in predicting fibrosis progression in nonalcoholic fatty liver disease[J]. Hepatology, 2020, 71(3): 849-860. DOI: 10.1002/hep.30974. [16] YIN M, GLASER KJ, TALWALKAR JA, et al. Hepatic MR elastography: clinical performance in a series of 1377 consecutive examinations[J]. Radiology, 2016, 278(1): 114-124. DOI: 10.1148/radiol.2015142141. [17] PARK CC, NGUYEN P, HERNANDEZ C, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease[J]. Gastroenterology, 2017, 152(3): 598-607. e2. DOI: 10.1053/j.gastro.2016.10.026. [18] IMAJO K, HONDA Y, KOBAYASHI T, et al. Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease[J]. Clin Gastroenterol Hepatol, 2022, 20(4): 908-917. e11. DOI: 10.1016/j.cgh.2020.12.016. [19] SERRA-BURRIEL M, GRAUPERA I, TORÁN P, et al. Transient elastography for screening of liver fibrosis: Cost-effectiveness analysis from six prospective cohorts in Europe and Asia[J]. J Hepatol, 2019, 71(6): 1141-1151. DOI: 10.1016/j.jhep.2019.08.019. [20] DINANI AM, KOWDLEY KV, NOUREDDIN M. Application of artificial intelligence for diagnosis and risk stratification in NAFLD and NASH: the state of the art[J]. Hepatology, 2021, 74(4): 2233-2240. DOI: 10.1002/hep.31869. [21] WONG GL, YUEN PC, MA AJ, et al. Artificial intelligence in prediction of non-alcoholic fatty liver disease and fibrosis[J]. J Gastroenterol Hepatol, 2021, 36(3): 543-550. DOI: 10.1111/jgh.15385. [22] LIU F, GOH GB, TINIAKOS D, et al. qFIBS: An automated technique for quantitative evaluation of fibrosis, inflammation, ballooning, and steatosis in patients with nonalcoholic steatohepatitis[J]. Hepatology, 2020, 71(6): 1953-1966. DOI: 10.1002/hep.30986. [23] SARVESTANY SS, KWONG JC, AZHIE A, et al. Development and validation of an ensemble machine learning framework for detection of all-cause advanced hepatic fibrosis: a retrospective cohort study[J]. Lancet Digit Health, 2022, 4(3): e188-e199. DOI: 10.1016/S2589-7500(21)00270-3.
本文二维码
计量
- 文章访问数: 781
- HTML全文浏览量: 595
- PDF下载量: 101
- 被引次数: 0