NAFLD and NASH pp 115-139 | Cite as

Non-invasive Assessment of Non-alcoholic Fatty Liver Disease: Ultrasound and Transient Elastography

  • Tao Wan
  • Annalisa BerzigottiEmail author


Ultrasound (US) is the most common imaging method used to diagnose liver steatosis worldwide due to its wide availability, safety, and relatively low cost. The typical findings include increased a bright liver appearance, attenuation of the ultrasound signal and blurring of the intrahepatic vessels walls. US provides a qualitative assessment of the presence of steatosis >15–20% of hepatocytes, but it has important limitations, including its operator-dependency, poor sensitivity for the detection of very mild steatosis and limited ability of providing a proper quantitative assessment of the fat content. Controlled Attenuation Parameter (CAP) by vibration controlled transient elastography is a quantitative parameter for steatosis obtained simultaneously to liver stiffness. It might be more sensitive than ultrasound for mild steatosis and has an excellent accuracy for severe steatosis. In patients with NAFLD, liver stiffness measurement using transient elastography or other ultrasound elastography techniques is able to rule-out liver fibrosis, and to identify severe fibrosis/cirrhosis. Mild increases of liver stiffness can be due either to liver fibrosis or to inflammation in patients with NASH. This chapter reviews the current evidence regarding the non-invasive diagnosis and characterization of NAFLD/NASH using ultrasound and ultrasound elastography, and provides a short overview of upcoming ultrasound techniques.


Liver steatosis Liver fibrosis Cirrhosis Scattering Shear-wave 



Tao Wan is supported by a scholarship by the China Scholarship Council (CSC).


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Hepatology, University Clinic for Visceral Surgery and Medicine (UVCM), Inselspital and Department of Biomedical Research (DBMR)University of BernBernSwitzerland
  2. 2.Department of Hepatobiliary SurgeryThe Third Xiangya Hospital, Central South UniversityChangshaChina

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