Global statistics show an increasing percentage of patients that develop non-alcoholic fatty liver disease (NAFLD) and NAFLD-related hepatocellular carcinoma (HCC), even in the absence of cirrhosis. In the present review, we analyzed the diagnostic performance of ultrasonography (US) in the non-invasive evaluation of NAFLD and NAFLD-related HCC, as well as possibilities of optimizing US diagnosis with the help of artificial intelligence (AI) assistance. To date, US is the first-line examination recommended in the screening of patients with clinical suspicion of NAFLD, as it is readily available and leads to a better disease-specific surveillance. However, the conventional US presents limitations that significantly hamper its applicability in quantifying NAFLD and accurately characterizing a given focal liver lesion (FLL). Ultrasound contrast agents (UCAs) are an essential add-on to the conventional B-mode US and to the Doppler US that further empower this method, allowing the evaluation of the enhancement properties and the vascular architecture of FLLs, in comparison to the background parenchyma. The current paper also explores the new universe of AI and the various implications of deep learning algorithms in the evaluation of NAFLD and NAFLD-related HCC through US methods, concluding that it could potentially be a game changer for patient care.
Among patients with chronic hepatitis C (CHC) infection, extensive research showed that fibrosis progression is a proper surrogate marker for advanced liver disease, eventually leading to dramatic endpoints such as cirrhosis and hepatocellular carcinoma. Therefore, there is growing interest in the use of noninvasive methods for fibrosis assessment in order to replace liver biopsy (LB) in clinical practice and provide optimal risk stratification. Elastographic techniques, such as Vibration Controlled Transient Elastography (VCTE), point-shear wave elastography (p-SWE), and 2D-SWE have shown promising results in this regard, with excellent performance in diagnosing hepatic cirrhosis, and great accuracy for steatosis detection through the Controlled Attenuation Parameter embedded on the VCTE device. In addition, the recent introduction of highly efficient direct-acting antivirals (DAAs) led to viral eradication and a significant decrease in liver damage, lowering the risk of hepatic decompensation, and HCC. Therefore, CHC patients need proper noninvasive and repeatable methods for adequate surveillance, even after treatment, as there still remains a risk of portal hypertension and HCC. However, the usefulness for monitoring fibrosis after the sustained virological response (SVR) needs further research.
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