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.

2 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 . 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).

3 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 . 5 AUROC (95 CI, ) . 38) . Tada UGAP Attenuation Coefficient PDFF . (n=126 B C ) 95 CI.

4 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.

5 ( ) 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) .. 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.

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8 Hepatology 2013; 58:1930- 1940. 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.

9 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. 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.

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