Fatty liver disease in severe obese patients: Diagnostic value of abdominal ultrasound

Almeida, Alessandro de Moura; Cotrim, Helma Pinchemel; Barbosa, Daniel Batista Valente; Athayde, Luciana Gordilho Matteoni de; Santos, Adimeia Souza; Bitencourt, Almir Galvão Vieira; Freitas, Luiz Antônio Rodrigues de; Rios, Adriano; Alves, Erivaldo

doi:10.3748/wjg.14.1415

Cited by 104 publications

(35 citation statements)

References 17 publications

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“…Data on the reliability of ultrasound in assessing histological steatosis, fibrosis, and the presence of NASH in patients undergoing bariatric surgery are also inconsistent [15, 32, 33]. Ultrasound is notoriously operator dependent, and verification of the ultrasound findings by a second reviewer was not carried out in this study.…”

Section: Discussionmentioning

confidence: 98%

Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

Petrick¹,

Benotti²,

Wood³

et al. 2015

OBES SURG

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Background Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of preoperative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. Methods Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. Results The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95–98 % and a specificity of 28–48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12–22 % and a specificity of 89–97 % for major histologic findings in NAFLD/NASH. Conclusions Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful.

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Section: Discussionmentioning

confidence: 98%

Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

Petrick¹,

Benotti²,

Wood³

et al. 2015

OBES SURG

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“…Current conventional ultrasonic techniques do not allow for quantification of the degree of fatty liver. The effectiveness of ultrasound for liver disease detection is reduced in patients who are morbidly obese (sensitivity is reduced to below 40%) (de Almeida et al 2008). For conventional ultrasound to detect steatosis, the degree of fat infiltration in the liver must be above 30% (Fishbein et al 1997; Mehta et al 2008; Dasarathy et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Ex vivo Study of Quantitative Ultrasound Parameters in Fatty Rabbit Livers

Ghoshal

Lavarello

Kemmerer

et al. 2012

Ultrasound in Medicine & Biology

109

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Nonalcoholic fatty liver disease (NAFLD) affects more than 30% of Americans, and with increasing problems of obesity in the United States, NAFLD is poised to become an even more serious medical concern. At present, accurate classification of steatosis (fatty liver) represents a significant challenge. In this study, the use of high-frequency (8 to 25 MHz) quantitative ultrasound (QUS) imaging to quantify fatty liver was explored. QUS is an imaging technique that can be used to quantify properties of tissue giving rise to scattered ultrasound. The changes in the ultrasound properties of livers in rabbits undergoing atherogenic diets of varying durations were investigated using QUS. Rabbits were placed on a special fatty diet for 0, 3, or 6 weeks. The fattiness of the livers was quantified by estimating the total lipid content of the livers. Ultrasonic properties, such as speed of sound, attenuation, and backscatter coefficients, were estimated in ex vivo rabbit liver samples from animals that had been on the diet for varying periods. Two QUS parameters were estimated based on the backscatter coefficient: effective scatterer diameter (ESD) and effective acoustic concentration (EAC), using a spherical Gaussian scattering model. Two parameters were estimated based on the backscattered envelope statistics (the k parameter and the μ parameter) according to the homodyned K distribution. The speed of sound decreased from 1574 to 1565 m/s and the attenuation coefficient increased from 0.71 to 1.27 dB/cm/MHz, respectively, with increasing fat content in the liver. The ESD decreased from 31 to 17 μm and the EAC increased from 38 to 63 dB/cm3 with increasing fat content in the liver. A significant increase in the μ parameter from 0.18 to 0.93 scatterers/mm3 was observed with increasing fat content in the liver samples. The results of this study indicate that QUS parameters are sensitive to fat content in the liver.

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“…Ultrasound often reveals a hyperechoic texture consistent with fatty infiltration, having reported sensitivity and specificity of about 85% and 94% for NAFL and NASH, respectively 24. The sensitivity of ultrasonography decreases in the case of obesity 25. Computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS) can identify steatosis but are not sufficiently sensitive to detect inflammation or fibrosis 26.…”

Section: Imagingmentioning

confidence: 99%

Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies

Vizuete¹,

Camero²,

Malakouti³

et al. 2017

Journal of Clinical and Translational Hepatology

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Nonalcoholic fatty liver disease (NAFLD) represents a major public health epidemic. Pharmacologic therapies for this condition are scarce, but multiple agents with novel mechanisms of action are in development. Here we review the pathophysiology and natural history of NALFD, diagnostic testing and data for currently available treatment strategies. We then turn our attention to promising developmental drugs and their respective trials. As the prevalence of fatty liver disease increases, clinicians will have more tools at hand for management of this condition. We conclude the horizon is bright for patients and doctors who deal with NAFLD. Citation of this article: Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J. Perspectives on nonalcoholic fatty liver disease: an overview of present and future therapies.

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Fatty liver disease in severe obese patients: Diagnostic value of abdominal ultrasound

Cited by 104 publications

References 17 publications

Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

Ex vivo Study of Quantitative Ultrasound Parameters in Fatty Rabbit Livers

Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies

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