Nonalcoholic fatty liver disease and diabetes

Table 1 Pros and cons of imaging modalities to assess hepatic steatosis

Modality	Pros	Cons
US B-Mode	Lack of ionizing radiation	No panoramic view
	Less expensive	Operator dependency
	Repeatable	Limited accuracy diagnosing mild hepatic steatosis
	Fast	Rather qualitative nature
	Can be performed at the bedside (no need to transport the patient)	Non simple steatosis/NASH differentiation
	Useful also for identification of other pathology such as liver lesions
QUS	Same as US B-Mode	Not always available
	Quantitative and semiquantitative fat evaluation (less operator sensitive)	Need to buy newer machines and software
Fibroscan	Quantitative evaluation (less operator sensitive)	Expensive equipment that doesn’t supply imaging evaluation
	Lack of ionizing radiation
	Fast
	Can be performed at the bedside (no need to transport the patient)
CT	Fast	Ionizing radiation
	Panoramic view	Limited accuracy diagnosing mild hepatic steatosis
	Volumetric rendering	Non simple steatosis/NASH differentiation
	High spatial resolution
	Quantitative density evaluation
MRI	Highly accurate and reproducible for measuring hepatic fat	Expensive
	Panoramic view	Examination time
	Lack of ionizing radiation	Software not always available
	Quantitative fat evaluation
MRS	Highly accurate and reproducible for measuring hepatic fat	Expensive
	Panoramic view	Examination time
	Lack of ionizing radiation	Software not always available
	Quantitative fat evaluation	Evaluation of small portion of the liver
		Expertise required for data acquisition and analysis

CT: Computed tomography; MRI: Magnetic resonance imaging; MRS: Magnetic resonance spectroscopy; NASH: Nonalcoholic steatohepatitis; QUS: Quantitative ultrasound; US: Ultrasound.