Steatotic liver disease: radiological and ultrasound point of view

Background. The article presents the data of the Delphi consensus of world scientific communities on the new nomenclature of steatotic liver disease discussion, published in the summer of 2023, European clinical guidelines for the management of patients with steatotic liver disease associated with metabolic dysfunction in 2024, World clinical guidelines for the use of ultrasound in medicine and biology for multiparametric liver examination in 2024 and data with an emphasis on the features of instrumental diagnostics in new conditions, taking into account the characteristics of healthcare in the Russian Federation (based on the results of our own research). Aim. To assess the possibilities of the instrumental research methods integrated application for the diagnosis of steatotic liver disease associated with metabolic dysfunction at the stages of steatosis, inflammation, fibrosis. Materials and methods. Five hundred forty nine patients were examined – 252 (45.9%) men, 297 (54.1%) women aged 18 to 78 years. Inclusion criteria: the presence of liver steatosis according to at least one imaging method (ultrasound, MDCT, MRI), assessed retrospectively and at least 1 cardiometabolic criterion. The control group included 278 patients without signs of liver steatosis according to instrumental research methods, including 144 (51.8%) men, 40 (48.2%) women aged 18 to 68 years. All patients were examined with a single diagnostic algorithm consisting of 5 stages: clinical and laboratory stage, physical examination, ultrasound, dual-energy X-ray absorptiometry in the “Whole Body” mode, retrospective analysis of MDCT and/or MRI studies. Liver biopsy with subsequent histological examination according to the SAF scale was performed in 38 patients. Results. The data of ultrasound steatometry and shear wave elastography, dual-energy X-ray absorptiometry in the “Whole Body” mode, as well as MDCT of the abdominal organs are compared with expert opinions and meta-analyses. Dissonance was found between the draft Russian clinical guidelines for non-alcoholic fatty liver disease of 2022, where the diagnostic part is based on the methods that were the main ones 10–20 years ago. Conclusion. The draft Russian clinical guidelines lack sufficient data on optimizing the assessment of liver steatosis using modern imaging methods. A multidisciplinary discussion is proposed to develop balanced, personalized, unified diagnostic approaches.