title: Role of ultrasound in the diagnosis and treatment of nonalcoholic fatty liver disease and its complications.
abstract: We review the role of liver ultrasonography (US) and related techniques as non-invasive tools in predicting metabolic derangements, liver histology, portal hypertension and cardiovascular risk as well as allowing early diagnosis and management of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. In this setting, US detects fatty changes as low as ≥20% and hepatic steatosis identified ultrasonographically, in its turn, closely mirrors coronary and carotid atherosclerosis burden. Semi-quantitative US indices (to exclude nonalcoholic steatohepatitis) and sonoelastography (to quantify fibrosis) help in predicting liver histology and selecting patients to submit to liver biopsy. Surveillance for hepatocellular carcinoma conducted through biannual US is mandatory and US has a role in guiding locoregional treatment and in evaluating the efficacy of treatment. High-intensity focused ultrasound can be delivered with precision resulting in coagulative necrosis of hepatocellular carcinoma without puncturing the liver. Costs and inconveniences have so far hampered its diffusion.
authors.affiliation: Division of Internal Medicine, Hospital of Pavullo - Department of Internal Medicine, Azienda USL, Pavullo, Modena 41126, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ballestri
authors.forename: Dante
authors.initials: D
authors.lastname: Romagnoli
authors.forename: Fabio
authors.initials: F
authors.lastname: Nascimbeni
authors.forename: Giampiero
authors.initials: G
authors.lastname: Francica
authors.forename: Amedeo
authors.initials: A
authors.lastname: Lonardo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000209:etiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology; D054459:Elasticity Imaging Techniques; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy; D018608:Ultrasonography, Doppler
keywords: NASH; cardiovascular risk; cirrhosis; elastography; fatty liver; hepatocellular carcinoma; liver biopsy; liver fibrosis; metabolic syndrome; portal hypertension; ultrasound