Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease: A Step Forward for Better Evaluation Using Ultrasound Elastography

Abstract

The increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in the general population prompts for a quick response from physicians. As NAFLD can progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), new non-invasive, rapid, cost-effective diagnostic methods are needed. In this review, we explore the diagnostic performance of ultrasound elastography for non-invasive assessment of NAFLD and NAFLD-related HCC. Elastography provides a new dimension to the conventional ultrasound examination, by adding the liver stiffness quantification in the diagnostic algorithm. Whilst the most efficient elastographic techniques in staging liver fibrosis in NAFLD are vibration controlled transient elastography (VCTE) and 2D-Shear wave elastography (2D-SWE), VCTE presents the upside of assessing steatosis through the controlled attenuation parameter (CAP). Hereby, we have also critically reviewed the most important elastographic techniques for the quantitative characterization of focal liver lesions (FLLs), focusing on HCC: Point shear wave elastography (pSWE) and 2D-SWE. As our paper shows, elastography should not be considered as a substitute for FLL biopsy because of the stiffness values overlap. Furthermore, by using non-invasive, disease-specific surveillance tools, such as US elastography, a subset of the non-cirrhotic NAFLD patients at risk for developing HCC can be detected early, leading to a better outcome. A recent ultrasomics study exemplified the wide potential of 2D-SWE to differentiate benign FLLs from malignant ones, guiding the clinician towards the next steps of diagnosis and contributing to better long-term disease surveillance.

Ultrasound Methods in the Evaluation of Atherosclerosis: From Pathophysiology to Clinic

“…In clinical practice, elastography techniques are increasingly useful in various circumstances and largely used for the evaluation of diffuse liver diseases [ 58 ]. Nonetheless, rising evidence suggests that US elastography allows adequate evaluation of the mechanical properties of plaques, displaying promising results for plaque vulnerability assessment [ 59 , 60 ].…”

Performance of Ultrasound Techniques and the Potential of Artificial Intelligence in the Evaluation of Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease

“…In addition, the controlled attenuation parameter (CAP) measured by the vibration controlled transient elastography (VCTE), a widely available device, has a powerful contribution in steatosis evaluation. The potential of US elastography is a subject of high interest in the non-invasive evaluation of NAFLD and NAFLD-related HCC, as previously exemplified in a recent paper from our group [ 14 ].…”

“…It is well known that the presence and severity of fibrosis are important prognostic factors in NAFLD. Using combinations of non-invasive methods, such as composite scoring systems and/or transient elastography, enabled risk stratification of patients by fibrosis stage [ 13 , 14 ].…”

“…However, this technology encounters several limitations in the NAFLD population, considering that the body mass index (BMI) among these subjects is usually increased [ 17 ]. In addition, current guidelines lack specific recommendations for primary HCC prevention and, moreover, do not include clear recommendations for a cost-effective surveillance of the non-cirrhotic NAFLD patients carrying a risk of HCC development [ 14 , 18 ]. Surveillance among these individuals remains controversial since mass screening using conventional US has low cost-effectiveness [ 19 ].…”

Polygenic risk score: A promising predictor for hepatocellular carcinoma in the population with non-alcoholic fatty liver disease

“…In general, the traditional thresholds for AUC are defined as follows: 0.5, no discrimination; 0.5-0.7, poor discrimination; ≥ 0.7, acceptable discrimination; ≥ 0.8, excellent discrimination; and ≥ 0.9, outstanding discrimination [2]. An important question to address in future studies would be to investigate whether inherited or de novo genetic factors such as copy number variants, methylation marks, and rare but highly penetrant polymorphisms not captured in this analysis of common variants or other noninvasive assessments, such as ultrasound elastography [3], can be integrated to generate a comprehensive risk score to enhance the predictive ability of PRS. In addition, this study used AUC to evaluate the predictive performance of PRS J o u r n a l P r e -p r o o f [1].…”