The value of transabdominal ultrasound for assessment of the severity of liver steatosis as compared to liver biopsy

• Authors: Ioan Sporea , Roxana Şirli , Elena Başa , Maria Cornianu , Alina Popescu , Mirela Dănilă , Mircea Focşa
• Languages of publication: EN

Abstracts

EN

The purpose of our paper was to evaluate the performance of ultrasound (US) for assessment of the severity of liver steatosis as compared to a pathological examination, which is presently considered to be the gold standard, in patients that have undergone liver biopsy for various reasons. We performed echo-assisted liver biopsy in 161 patients with chronic hepatitis with the US aspect of “bright liver” with “posterior attenuation”, using modified Menghini needles. Following the US examination, the severity of liver steatosis was estimated as minimal, mild, moderate. or severe according to the Hepburn classification: absent (affecting 0% to 2% of the hepatocytes), minimal (2% to 10%), mild (10% to 30%), moderate (30% to 60%), and severe (more than 60% of the hepatocytes). The results of this study showed that the sensitivity of US for the prediction of histological steatosis of at least moderate severity was 0.64, with 0.77 specificity, 0.55 positive predictive value, and 0.94 negative predictive value. The overall accuracy was 0.75. This study showed that the transabdominal ultrasound evaluation of the fatty liver is a quite good predictor, perhaps sufficient for most purposes, for the estimation of the severity of liver steatosis in the moderate to severe range.

Keywords

EN

“Fatty liver”; Ultrasound; Hepatic biopsy

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2009
• Volume: 4
• Issue: 4
• Pages: 490-495

Dates

published

1 - 12 - 2009

online

3 - 10 - 2009

Contributors

author

Ioan Sporea

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300736, Timişoara, România

author

Roxana Şirli

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300736, Timişoara, România

author

Elena Başa

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300736, Timişoara, România

author

Maria Cornianu

• Department of Pathology, University of Medicine and Pharmacy Timişoara, 300736, Timişoara, România

author

Alina Popescu

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300736, Timişoara, România

author

Mirela Dănilă

• Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy Timişoara, 300736, Timişoara, România

author

Mircea Focşa

• Department of Biophysics and Medical Informatics, University of Medicine and Pharmacy Timişoara, 300173, Timişoara, România

References

• [1] Zelber-Sagi S., Nitzan-Kaluski D., Halpern Z., Oren R., Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures., Liver International, 2006, 26, 856–863 http://dx.doi.org/10.1111/j.1478-3231.2006.01311.x[Crossref][WoS]
• [2] Abdelmalek M.F., Diehl A.M., Nonalcoholic fatty liver disease as a complication of insulin resistance., Med. Clin. North. Am., 2007, 91(6),1125–1149 http://dx.doi.org/10.1016/j.mcna.2007.06.001[Crossref][WoS]
• [3] Bedogni G., Bellentani S., Fatty liver, how frequent is it and why?, Ann. Hepatol., 2004, 3, 63–65 [PubMed]
• [4] Negro F., Insulin resistance and HCV, will new knowledge modify clinical management?, Journal of Hepatology, 2006, 45, 514–519 http://dx.doi.org/10.1016/j.jhep.2006.07.011[Crossref]
• [5] Falck-Ytter Y., Younossi Z.M., Marchesini G., McCullough A.J., Clinical feature and natural history of nonalcoholic steatosis syndromes., Semin. Liver. Dis., 2001, 21, 17–26 http://dx.doi.org/10.1055/s-2001-12926[Crossref]
• [6] Ratziu V., Giral.P, Charlotte F., Bruckert E., Thibault V., Theodorou I. et al, Liver fibrosis in overweight patients., Gastroenterology, 2000, 118, 1117–1123 http://dx.doi.org/10.1016/S0016-5085(00)70364-7[Crossref]
• [7] Adams L.A., Lymp J.F., Sauver J., Sanderson S.O., Lindor K.D., Feldstein A. et al, The natural history of nonalcoholic fatty liver disease, a population-based cohort study., Gastroenterology, 2005, 129, 113–121 http://dx.doi.org/10.1053/j.gastro.2005.04.014[Crossref]
• [8] Munteanu M., Ratziu V., Morra R., Messous D., Imbert-Bismut F., Poynard T., Noninvasive biomarkers for the screening of fibrosis, steatosis and steatohepatitis in patients with metabolic risk factors: FibroTest-FibroMax experience., J. Gastrointestin Liver Dis., 2008, 17(2), 187–191
• [9] Lydatakis H., Hager I.-P., Kostadelou E., Mpousmpoulas S., Pappas S., Diamantis I., Noninvasive markers to predict the liver fibrosis in nonalcoholic fatty liver disease., Liver International, 2006, 26, 864–871 http://dx.doi.org/10.1111/j.1478-3231.2006.01312.x[Crossref]
• [10] Sanyal A.J., AGA technical review on nonalcoholic fatty liver disease., Gastroenterology 2002, 123, 1705–1725 http://dx.doi.org/10.1053/gast.2002.36572[Crossref]
• [11] Tobari M., Hashimoto E., Yatsuji S., Torii N., Taniai M., Tokushige K. et al, The usefulness of ultrasonography and computerized tomography in imaging of nonalcoholic steatohepatitis., Hepatology, 2006, 44(S1), 658A
• [12] Browning J.D., Szczepaniak L.S., Dobbins R., Nuremberg P., Horton J.D., Cohen J.C. et al, Prevalence of hepatic steatosis in an urban population in United States: impact of ethnicity., Hepatology, 2004, 40, 1387–1395 http://dx.doi.org/10.1002/hep.20466[Crossref]
• [13] Matteoni C.A., Younossi Z.M., Gramlich T., Boparai N., Liu Y.C., McCullough A.J., Nonalcoholic fatty liver disease, a spectrum of clinical and pathological severity., Gastroenterology, 1999, 116, 1413–1419 http://dx.doi.org/10.1016/S0016-5085(99)70506-8[Crossref]
• [14] Al Knawy B., Shiffman M., Percutaneous liver biopsy in clinical practice., Liver Int. 2007, 27(9), 1166–1173 http://dx.doi.org/10.1111/j.1478-3231.2007.01592.x[Crossref]
• [15] Hepburn J.M., Vos J.A., Fillman E.P., Lawitz E.J., The accuracy of the report of hepatic steatosis on ultrasonography in patients infected with hepatitis C in a clinical setting: A retrospective observational study., BMC Gastroenterol., 2005, 5, 14–28 http://dx.doi.org/10.1186/1471-230X-5-14[Crossref]
• [16] Palmentieri B., de Sio I., La Mura V., Masarone M., Vecchione R., Bruno S. et al, The role of liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis., Dig. Liver. Dis., 2006, 38, 485–489 http://dx.doi.org/10.1016/j.dld.2006.03.021[Crossref]
• [17] Mathiesen U.L., Franzen L.E., Aselius H., Resjö M., Jacobsson L., Foberg U. et al, Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases., Dig. Liver. Dis., 2002, 34, 516–522 http://dx.doi.org/10.1016/S1590-8658(02)80111-6[Crossref]
• [18] Fishbein M., Castro F., Cheruku S., Jain S., Webb B., Gleason T. et al, Hepatic MRI for fat quantification, its relationship to fat morphology, diagnosis and ultrasound., J. Clin. Gastroenterol., 2005, 39, 619–625 http://dx.doi.org/10.1097/00004836-200508000-00012[Crossref]
• [19] Kim S.H., Lee J.M., Kim J.M., Kim K.G., Han J.K., Lee K.H. et al, Appropriateness of a donor liver with respect to macrosteatosis, application of artificial neural networks to US images- initial experience., Radiology, 2005, 234, 793–803 http://dx.doi.org/10.1148/radiol.2343040142[Crossref]
• [20] Gaitini D., Lederman M., Baruch Y., Ghersin E., Veitsman E., Kerner H. et al, Computerized analysis of liver texture with correlation to needle biopsy., European J. Ultrasound 2005, 26, 197–202
• [21] Ataseven H., Yildirim M.H., Yalniz M., Bahcecioglu I.H., Celebi S., Ozercan I.H., The value of ultrasonography and computerized tomography in estimating the histopathological severity of nonalcoholic steatohepatitis., Acta Gastroenterol. Belg., 2005, 68, 221–225
• [22] Saadeh S., Younossi Z.M., Remer E.M., Gramlich T., Ong J.P., Hurley M. et al, The utility of radiological imaging in nonalcoholic fatty liver disease., Gastroenterology 2002, 123, 745–750 http://dx.doi.org/10.1053/gast.2002.35354[Crossref]
• [23] Joseph A.E., Saverymuttu S.H., al-Sam S., Cook M.G., Maxwell J.D., Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease., Clin. Radiol., 1991, 43, 26–31 http://dx.doi.org/10.1016/S0009-9260(05)80350-2[Crossref]

Identifiers

DOI

10.2478/s11536-009-0067-9