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2019 年5月 日本超音波医学会 用語・診断基準委員会

( ).. 2019 5 .. 2019 5 . 2018 6 . 2017 5 . 2016 10 . 2016 5 . 2013 5 .. 2 1 non- alcoholic fatty liver disease nafld nafld .. non-alcoholic steatohepatitis NASH . nonalcoholic fatty liver (NAFL) 1,2,3) . NASH 5 ballooning) . 4) . NASH nafld . 1 2 1) . 1980 1984. 10 1995 25 5) . 6) . 5) . ( ) .. NASH gold standard .. Magnetic Resonance Imaging (MRI proton density fat fraction PDFF controlled attenuation parameter CAP . 7,8,9). 5 1 . 10) . 1 1) ( 1) . MRI .. 11,12) . B .. 1) 30g/ 20g/ . nafld 1,2,3) .. ( .. 1,2) 5 . 2) . B . 3). B .. nafld . NASH . 13,14,15,16) NASH NAFL . 17) .. NAFL NASH . 13) .. 2 30 . nafld 5 . 1,2,3) 30 . CT L/S ) . CT 30 . 21) 30 . 10 ) . 22) . 3 B 30 . 23,24,25) 30 . 26,27,28) B 5 .. 5 . 29-36) .. 5 .. NAFL NASH .. B .. 28) .. f =a f n(dB/cm) (n 1 . ) a(dB/MHz/cm) .. CAP Echosens Paris France)8,9,29-36) . Attenuation imaging ATI . 38,41). Ultrasound-guided attenuation parameter UGAP GE.

NAFLDの中には肝硬変 や肝癌に至ることのある進行性の一群があることが明らかにされ、これらは non-alcoholic steatohepatitis(NASH)と呼ばれ、比較的良性の経過をたどる ことの多いnonalcoholic fatty liver (NAFL)とは区別して分類されている1,2,3)。

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  Fatty, Alcoholics, Liver, Nafld, Nonalcoholic, Non alcoholic, Nonalcoholic fatty liver

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Transcription of 2019 年5月 日本超音波医学会 用語・診断基準委員会

1 ( ).. 2019 5 .. 2019 5 . 2018 6 . 2017 5 . 2016 10 . 2016 5 . 2013 5 .. 2 1 non- alcoholic fatty liver disease nafld nafld .. non-alcoholic steatohepatitis NASH . nonalcoholic fatty liver (NAFL) 1,2,3) . NASH 5 ballooning) . 4) . NASH nafld . 1 2 1) . 1980 1984. 10 1995 25 5) . 6) . 5) . ( ) .. NASH gold standard .. Magnetic Resonance Imaging (MRI proton density fat fraction PDFF controlled attenuation parameter CAP . 7,8,9). 5 1 . 10) . 1 1) ( 1) . MRI .. 11,12) . B .. 1) 30g/ 20g/ . nafld 1,2,3) .. ( .. 1,2) 5 . 2) . B . 3). B .. nafld . NASH . 13,14,15,16) NASH NAFL . 17) .. NAFL NASH . 13) .. 2 30 . nafld 5 . 1,2,3) 30 . CT L/S ) . CT 30 . 21) 30 . 10 ) . 22) . 3 B 30 . 23,24,25) 30 . 26,27,28) B 5 .. 5 . 29-36) .. 5 .. NAFL NASH .. B .. 28) .. f =a f n(dB/cm) (n 1 . ) a(dB/MHz/cm) .. CAP Echosens Paris France)8,9,29-36) . Attenuation imaging ATI . 38,41). Ultrasound-guided attenuation parameter UGAP GE.

2 37,39,42 Attenuation coefficient (ATT . )40) . 1 5% . (%) (%) Cut-off AUROC. 29). Chan WK 161 CAP 263dB/m Karlas T 30) 61 CAP 31). Lee HW 183 CAP 247dB/m Chan WK 32) 79 CAP 266dB/m Park CC 33) 104 CAP 261dB/m 34). Karlas T 2735 CAP 248dB/m Runge JH 35) 55 CAP 260dB/m Caussy C 36) 119 PDFF CAP 288dB/m 37). Fujiwara Y 163 CAP 248dB/m Tada T 38) 148 ATI 37). Fujiwara Y 163 UGAP Tada T 39) 126 PDFF UGAP Tamaki N 40) 351 ATT 72 72 5-10 CAP controlled attenuation parameter PDFF proton density fat fraction ATI Attenuation imaging UGAP Ultrasound-guided attenuation parameter ATT Attenuation coefficient AUROC area under the receiver operating characteristic curve Karlas 15 nafld 46 . ( ) CAP r= 95 CI 5 . AUROC area under the receiver operating characteristic curve . 95 CI 30) . Runge 55 nafld ( ) CAP 5 . AUROC 95 CI . 260dB/m 35) Caussy 119 nafld PDFF . ( ) CAP 5 AUROC 95 . [CI] 288dB/m 36) . Tada 148 ( ) ATI.

3 5 AUROC (95 CI, ) . 38) . Tada UGAP Attenuation Coefficient PDFF . (n=126 B C ) 95 CI . 5 AUROC (95 . 39) Fujiwara . 182 ( ) UAPG r= p< ). 5 AUROC 95 ) . 37 . Tamaki 351 ATT . r= p< 5 AUROC . 40) .. 43 . B .. B .. B .. B [qualitative finding] . 5 ( . ) . 4) . 1) bright liver 44) . ( 2).. 5) . 2 . 2) hepatorenal echo contrast 45) . ( 3).. 6) . fatty bandless sign .. 3) hepatosplenic echo contrast) . ( 4).. ( 6) 7) . 3 4 . 5 . 4) attenuation 46) . ( 5).. 8 . 5) vascular blurring 47) . ( 6).. 6 .. 4) B .. STC .. 5) .. 6) .. 7 .. 8 . penetration .. STC: sensitivity time control .. CT HU .. semi-quantative finding 9). ( ) . ( ) . + .. + + 48,49,50) . ) 10) 7 8 9 . A) Gain ( ). [ ] . B) . ( ) Gain ( ) . [ ] . ( ) Gamma .. ( ) STC .. C) .. 2 . D) ( ) .. 7 8 ( ). 2) .. 3) .. 9) .. 9 ( ) .. 10) ( ) .. ( ) .. nafld .. ( 12 . 13)13,51) . 10 12) 11 51). 10 ) . 52) .. 28) .. 53-56) Magnetic Resonance Elastography (MRE) 57,58).

4 nafld . fibrosis score NFS / BMI[body mass index] 59 FIB-4 index( ALT AST )60) . 61) .. 62,63).. 12 nafld low risk 87% intermediate risk 12% high risk 1% 64) . 12 nafld .. B . B .. 1. NASH nafld 2015 2015. 2. nafld /NASH 2014 2014. 3. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of liver Diseases. Hepatology. 2018; 67:328-357. 4. Bedossa P, Poitou C, Veyrie N, et al. Histopathological algorithm and scoring system for evaluation of liver lesions in morbidly obese patients. Hepatology. 2012; 56: 1751-9. 5. : 14 2003 . 50 12 1867-1942. 6. Eguchi Y, Hyogo H, Ono M, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol. 2012; 47:586-95. 7.

5 Caussy C, Reeder SB, Sirlin CB, et al. Non-invasive, quantitative assessment of liver fat by MRI-PDFF as an endpoint in NASH trials. Hepatology. 2018; 68: 763-772. 8. Kwok R, Choi KC, Wong GL, et al. Screening diabetic patients for non- alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study. Gut 2016; 65: 1359-1368. 9. De L dinghen V, Wong GL, Vergniol J, et al. Controlled attenuation parameter for the diagnosis of steatosis in non-alcoholic fatty liver disease. J Gastroenterol Hepatol 2016; 31:848-855. 10. Rockey DC, Caldwell SH, Goodman ZD, et al. American Association for the Study of liver D. liver biopsy. Hepatology 2009; 49:1017-1044. 11. Noureddin M, Lam J, Peterson MR, et al. Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials. Hepatology 2013; 58:1930- 1940.

6 12. Bannas P, Kramer H, Hernando D, et al. Quantitative magnetic resonance imaging of hepatic steatosis: Validation in ex vivo human livers. Hepatology. 2015; 62:1444-55. 13. Angulo P, Kleiner DE, Dam-Larsen S, et al. liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With nonalcoholic fatty liver Disease. Gastroenterology. 2015; 149: 389-97. 14. Loomba R, Chalasani N. The Hierarchical Model of nafld : Prognostic Significance of Histologic Features in NASH. Gastroenterology. 2015. Aug; 149(2):278-81. 15. Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and meta-analysis. Hepatology. 2017; 65:1557-1565. 16. Hagstr m H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH. predicts mortality and time to development of severe liver disease in biopsy-proven nafld . J Hepatol.

7 2017 Dec; 67:1265-1273. 17. Singh S, Allen AM, Wang Z, et al. Fibrosis progression in nonalcoholic fatty liver vs nonalcoholic steatohepatitis: a systematic review and meta-analysis of paired-biopsy studies. Clin Gastroenterol Hepatol. 2015; 13: 643-54. 18. Yajima Y, Narui T, Ishii M, et al. Computed tomography in the diagnosis of fatty liver : Total lipid content and computed tomography number. Tohoku J exp Med1982; 337-42. 19. Park SH, Kim PN, Kim KW, et al Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology. 2006; 2 39:105-12. 20. Iwasaki M, Takada Y, Hayashi M, et al. Noninvasive evaluation of graft steatosis in living donor transplantation. Transplantation 2004; 78: 1501-5. 21. Lee SW, Park SH, Kim KW, et al. Unenhanced CT for assessment of macrovesicular hepatic steatosis in living liver donors: comparison of visual grading with liver attenuation index.

8 Radiology. 2007;. 244:479-85. 22. Franzen LE, Ekstedt M, Kechagias S, et al. Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting. Modern Pathology 2005; 18: 912-6. 23. Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver : a meta-analysis. Hepatology. 2011 2; 54:1082-90. 24. Lewis JR, Mohanty SR. nonalcoholic fatty liver disease: a review and update. Dig Dis Sci. 2010; 55:560-78. 25. Dasarathy S, Dasarathy J, Khiyami A, et al. Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study. J Hepatol. 2009; 51:1061-7. 26. Wieckowska A, Feldstein AE. Diagnosis of nonalcoholic fatty liver disease: invasive versus noninvasive. Semin liver Dis. 2008;. 28:386-95. 27. Bohte AE, van Werven JR, Bipat S, et al. The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis.

9 Eur Radiol. 2011;. 21:87-97. 28.. , Jpn J Med Ultrasonics 2015; 42: 201-224. 29. Chan WK, Nik Mustapha NR, et al. Controlled attenuation parameter for the detection and quantification of hepatic steatosis in non- alcoholic fatty liver disease. J Gastroenterol Hepatol. 2014;. 29:1470 6. 30. Karlas T, Petroff D, Garnov N, et al. Non-invasive assessment of hepatic steatosis in patients with nafld using controlled attenuation parameter and 1H-MR spectroscopy. PLoS One. 2014 Mar 17; 9(3):e91987. 31. Lee HW, Park SY, Kim SU, et al. Discrimination of nonalcoholic steatosis using transient elastography in patients with nonalcoholic fatty liver disease. PLoS One. 2016; 11:e0157358. 32. Chan WK, Nik Mustapha NR, et al. Controlled attenuation parameter using the FibroScan XL probe for quantification of hepatic steatosis for non-alcoholic fatty liver disease in an Asian population. United European Gastroenterol J.

10 2017; 5:76 85. 33. Park CC, Nguyen P, Hernandez C, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy proven nonalcoholic fatty liver disease. Gastroenterology. 2017; 152:598 . 607. 34. Karlas T, Petroff D, Sasso M, et al. Individual patient data meta- analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol. 2017 May; 66:1022-1030. 35. Runge JH, Smits LP, Verheij J, et al. MR Spectroscopy-derived Proton Density Fat Fraction Is Superior to Controlled Attenuation Parameter for Detecting and Grading Hepatic Steatosis. Radiology. 2018; 286:547-556. 36. Caussy C, Alquiraish MH, Nguyen P, et al. Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology. 2018; 67:1348- 1359. 37. Fujiwara Y, Kuroda H, Abe T, et al.


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