PDF(Pubmed)
Abstract：
Liver disease accounts for approximately 2 million deaths per year worldwide. All chronic liver diseases (CLDs), whether of toxic, genetic, autoimmune, or infectious origin, undergo typical histological changes in the structure of the tissue. These changes may include the accumulation of extracellular matrix material, fats, triglycerides, or tissue scarring. Noninvasive methods for diagnosing CLD, such as conventional B-mode ultrasound (US), play a significant role in diagnosis. Doppler US, when coupled with B-mode US, can be helpful in evaluating the hemodynamics of hepatic vessels and detecting US findings associated with hepatic decompensation. US elastography can assess liver stiffness, serving as a surrogate marker for liver fibrosis. It is important to note that interpreting these values should not rely solely on a histological classification. Contrast-enhanced US (CEUS) provides valuable information on tissue perfusion and enables excellent differentiation between benign and malignant focal liver lesions. Clinical evaluation, the etiology of liver disease, and the patient current comorbidities all influence the interpretation of liver stiffness measurements. These measurements are most clinically relevant when interpreted as a probability of compensated advanced CLD. B-mode US offers a subjective estimation of fatty infiltration and has limited sensitivity for mild steatosis. The controlled attenuation parameter requires a dedicated device, and cutoff values are not clearly defined. Quan-titative US parameters for liver fat estimation include the attenuation coefficient, backscatter coefficient, and speed of sound. These parameters offer the advantage of providing fat quantification alongside B-mode evaluation and other US parameters. Multiparametric US (MPUS) of the liver introduces a new concept for complete noninvasive diagnosis. It encourages examiners to utilize the latest features of an US machine, including conventional B-mode, liver stiffness evaluation, fat quantification, dispersion imaging, Doppler US, and CEUS for focal liver lesion characterization. This comprehensive approach allows for diagnosis in a single examination, providing clinicians worldwide with a broader perspective and becoming a cornerstone in their diagnostic arsenal. MPUS, in the hands of skilled clinicians, becomes an invaluable predictive tool for diagnosing, staging, and monitoring CLD.
摘要：
全世界每年约有200万例肝病死亡。所有慢性肝病（CLDs），是否有毒，遗传,自身免疫，或感染来源，经历组织结构的典型组织学变化。这些变化可能包括细胞外基质物质的积累，脂肪，甘油三酯，或组织疤痕。诊断CLD的非侵入性方法，例如传统的B型超声（US），在诊断中发挥重要作用。多普勒美国，当与B模式US耦合时，可能有助于评估肝血管的血流动力学和检测与肝功能失代偿相关的US发现。超声弹性成像可以评估肝脏硬度，作为肝纤维化的替代标志物。重要的是要注意，解释这些值不应该仅仅依赖于组织学分类。对比增强US（CEUS）提供了有关组织灌注的有价值的信息，并可以很好地区分良性和恶性局灶性肝脏病变。临床评价,肝病的病因，和患者当前的合并症都会影响肝脏硬度测量的解释。当被解释为补偿的高级CLD的概率时,这些测量在临床上是最相关的。B型US提供了对脂肪浸润的主观估计，并且对轻度脂肪变性的敏感性有限。受控的衰减参数需要专用的设备，和截止值没有明确定义。肝脏脂肪估计的定量US参数包括衰减系数，后向散射系数,和声音的速度。这些参数提供了与B模式评估和其他US参数一起提供脂肪定量的优点。肝脏的多参数US（MPUS）为完全非侵入性诊断引入了新概念。它鼓励考官利用美国机器的最新功能，包括传统的B模式，肝脏硬度评估，脂肪量化，色散成像,多普勒美国，和CEUS用于局灶性肝脏病变的表征。这种全面的方法可以在一次检查中进行诊断，为世界各地的临床医生提供更广阔的视野，并成为其诊断库的基石。MPUS,在熟练的临床医生手中，成为诊断的宝贵预测工具，分期,并监控CLD。
