医学
非酒精性脂肪肝
脂肪变性
肝硬化
内科学
胃肠病学
纤维化
脂肪肝
磁共振成像
临床试验
病理
疾病
放射科
作者
Nobuharu Tamaki,Veeral Ajmera,Rohit Loomba
标识
DOI:10.1038/s41574-021-00584-0
摘要
Hepatic steatosis is a key histological feature of nonalcoholic fatty liver disease (NAFLD). The non-invasive quantification of liver fat is now possible due to advances in imaging modalities. Emerging data suggest that high levels of liver fat and its temporal change, as measured by quantitative non-invasive methods, might be associated with NAFLD progression. Ultrasound-based modalities have moderate diagnostic accuracy for liver fat content and are suitable for screening. However, of the non-invasive imaging modalities, MRI-derived proton density fat fraction (MRI-PDFF) has the highest diagnostic accuracy and is used for trial enrolment and to evaluate therapeutic effects in early-phase clinical trials in nonalcoholic steatohepatitis (NASH). In patients with NAFLD without advanced fibrosis, high levels of liver fat are associated with rapid disease progression. Furthermore, changes on MRI-PDFF (≥30% decline relative to baseline) are associated with NAFLD activity score improvement and fibrosis regression. However, an inverse association exists between liver fat and complications of cirrhosis. Liver fat decreases as liver fibrosis progresses towards cirrhosis, and the clinical importance of quantitative measurements of liver fat differs by NAFLD status. As such, patients with NAFLD should be stratified by fibrosis severity to investigate the utility of quantitative measurements of liver fat for assessing NAFLD progression and prognosis. Imaging modalities are now available that enable non-invasive quantitative measurements of liver fat content. This Review highlights the various modalities and their use in clinical trials, discusses the clinical importance of hepatic steatosis for progression of nonalcoholic fatty liver disease and proposes how the new modalities might be used going forward.
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