Radiologia Brasileira - Publicação Científica Oficial do Colégio Brasileiro de Radiologia

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Idioma/Language: Português Inglês

Vol. 53 nº 1 - Jan. /Feb.  of 2020

REVIEW ARTICLE
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Page(s) 47 to 55

Ultrasound elastography in patients with fatty liver disease

Autho(rs): Luiza de Campos Moreira da Silva1; Julia Teixeira de Oliveira2; Sandra Tochetto3; Claudia Pinto Marques Souza de Oliveira4; Rosa Sigrist5; Maria Cristina Chammas6

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Keywords: Elasticity imaging techniques/methods; Ultrasonography/methods; Liver/diagnostic imaging; Fatty liver/diagnosis.

Descritores: Técnicas de imagem por elasticidade/métodos; Ultrassonografia/métodos; Fígado/diagnóstico por imagem; Fígado gorduroso/diagnóstico.

Abstract:
Hepatic steatosis, or fatty liver disease, occurs due to the accumulation of lipids in hepatocytes. When it becomes chronic, lobular inflammation develops and the disease can evolve to hepatic fibrosis, liver cirrhosis, or hepatocellular carcinoma. Early diagnosis is desirable because patients diagnosed in the early stage of the disease respond better to treatment. In the early stages of fatty liver disease, the physical examination is often unremarkable. Fatty liver disease and hepatic fibrosis can be diagnosed and monitored through laboratory tests, imaging, and biopsy. Among the imaging methods, ultrasound stands out as an effective means of diagnosing and following patients with liver disease. Ultrasound used in conjunction with elastography (ultrasound elastography) has recently shown great utility in the follow-up of such patients. Ultrasound elastography studies the degree of deformation (stiffness) of an organ or lesion, so that when there is hardening, fibrosis, or cirrhosis of the liver, those alterations are well demonstrated. In this review article, we discuss the application of the different types of ultrasound elastography for liver studies: transient elastography, point shear wave elastography, and two-dimensional shear wave elastography. Although magnetic resonance elastography may also be used in the analysis of liver fibrosis, it will not be addressed in this article.

Resumo:
Esteatose hepática ocorre pelo acúmulo de lipídios nos hepatócitos, sua cronificação cursa com inflamação lobular e evolui com fibrose hepática, cirrose e carcinoma hepatocelular. O diagnóstico precoce do acometimento hepático é desejável em razão da melhor resposta terapêutica dos pacientes na fase inicial da doença. O exame físico nas fases iniciais da doença não apresenta alterações. O diagnóstico e o controle evolutivo da esteatose e fibrose hepática podem ser realizados por exames laboratoriais, exames de imagens e biópsia. Entre os exames de imagem, destaca-se a ultrassonografia (US) no diagnóstico e acompanhamento dos pacientes com doença hepática. Atualmente, a US associada à elastografia vem se destacando para acompanhamento desses pacientes. A elastografia por US estuda o grau de deformação (ou dureza) do órgão ou lesão, de modo que quando há endurecimento do fígado, por fibrose ou cirrose, essa alteração é bem demonstrada na elastografia por US. Neste artigo de revisão nos propusemos a discutir a aplicação dos diversos tipos de elastografia por US para estudo do fígado: elastografia transitória, point-shear wave elastography e 2D-shear wave elastography. A elastografia por ressonância magnética também pode ser utilizada na análise de fibrose hepática, mas não será abordada neste artigo.

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1. Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; https://orcid.org/0000-0002-6051-4228
2. Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; https://orcid.org/0000-0002-8770-3096
3. Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; https://orcid.org/0000-0003-3588-2069
4. Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; https://orcid.org/0000-0002-2848-417X
5. Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; https://orcid.org/0000-0002-5780-4136
6. Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; https://orcid.org/0000-0001-7041-3079

Correspondence:
Luiza de Campos Moreira da Silva. FMUSP – Instituto de Radiologia
Rua Doutor Ovídio Pires de Campos, 75, Cerqueira César
São Paulo, SP, Brazil, 05403-010
Email: luiza.silva@fm.usp.br

Received 18 February 2019
Accepted after revision 12 April 2019

Publication date: 30/10/2019
 
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