ABSTRACT
This chapter examines the current use of elastographic techniques for diagnosing liver steatosis and fibrosis in nonalcoholic fatty liver disease (NAFLD) and differentiating simple steatosis from nonalcoholic steatohepatitis (NASH). Consequently, the use of noninvasive modalities, such as ultrasound-based techniques for diagnosis of NAFLD has evolved rapidly in the last few years to become the standard of care. In addition to standard 3D ultrasound, currently several newer elastographic technologies are available for the evaluation of fat and fibrosis in NAFLD, including vibration-controlled transient elastography, shear wave elastography and acoustic radiation force impulse elastography. The biopsy characteristics of NASH include inflammation, apoptosis (balloon degeneration) and fibrosis, and a key component of NAFLD management lies in identification of the subgroup of patients who develop NASH and fibrosis. The importance of staging fibrosis in NAFLD cannot be underestimated since fibrosis has the strongest correlation with clinical liver outcomes including morbidity and mortality.
