EVALUATION OF MULTIPArAMETrIC ECHOGrAPHY IN DIAGNOsIs OF NONALCOHOLIC FATTY LIVEr DIsEAsE IN TYPE 2 DIABETEs MELLITUs

INTrODUCTION Diabetes is one of the largest global health emergencies of the 21st century. according to the data of international Diabetes Federation (iDF) there are about 415 million people with diabetes and 318 million people with impaired glucose tolerance in the world. But there are also 193 million people with undiagnosed diabetes which are at high risk of developing chronic complications. iDF estimated that there would be 642 million people with diabetes by 2040. The proportion of type 2 diabetes mellitus (T2DM) is 91% among all adults with diabetes [1]. it is known that non-alcoholic fatty liver disease (NaFlD) is one of the causes of disability and mortality in patients with T2DM. in western countries NaFlD affects 1746% of adults. The stages of NaFlD are steatosis, steatohepatitis and steatotic cirrhosis. hepatocellular carcinoma is a complication of steatohepatitis even in the absence of cirrhosis [7]. Golden standard for diagnosis of NaFlD is liver biopsy, but this procedure can’t be part of ordinary investigation in patients with T2DM because of such possible complications as postoperative pain, bleeding, bacteremia, biliary peritonitis, pneumothorax, hemothorax, subcutaneous emphysema, inflammation and mortality. Computer tomography (CT) of abdominal cavity and magnetic resonance tomography (Mri) are expensive procedures and can’t be used for following patients up. That’s why there is need for noninvasive and affordable methods for diagnosis of NaFlD in patients with T2DM. These methods must be used for differentiation of the stages of steatosis, quantitative evaluation of liver fat and liver stiffness measurement simultaneously. The recommendation of the European association for the study of the liver defines ultrasound (us) as the preferred first-line diagnostic procedure for imaging of NaFlD as us robustly diagnoses moderate and severe steatosis and provides additional hepatobiliary information [7]. But it is impossible to evaluate liver fat in hepatocytes quantitatively in us B-mode. For diagnosis of fatty liver in B-mode the criteria of hamaguchi are used [11]. These criteria include hepatomegaly, attenuation of us in the liver in front posterior direction and vessel blurring. But the disadvantages of this method are differences in echogenicity of liver in healthy adults and operator-dependent interpretation of the results. hepatorenal index and evaluation of histogram of liver echogenicity differentiate stages of steatosis [4]. Fibroscan (Echosens, France) is widely used in Europe because it includes simultaneous liver stiffness measurement with transient elastography and assessment of steatosis with steatometry and controlled attenuation parameter (CaP) respectively [12]. CaP as a method is presented by correlation of stage of attenuation in liver parenchyma in dB/m with the stage of steatosis according to the morphological scale saF/Nas [14]. But more data are needed to define the role of CaP [7]. Transient elastography of Fibroscan (Echosens, France) is limited for diagnosis of NaFlD in patients with T2DM and excessive weight and obesity because shear waves can’t go through subcutaneous abdominal fat and there is no navigation of direction