Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases

Mathiesen, Ulrik; Franzén, LE; Åselius, H; Resjö, M; Jacobsson, Lars; Foberg, U; Frydén, Aril; Bodemar, Göran

doi:10.1016/s1590-8658(02)80111-6

Cited by 309 publications

(249 citation statements)

References 7 publications

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“…Excluding a possible mistake in the liver biopsy due to a sampling variation, our results showed that the reliability of BLP low grade was uncertain for LS. However, it is necessary to remark that the prevalence of ultrasound LS found in our study (in 60 % of patients in comparison to 30-47 % found from other authors always in patients with chronic hepatitis) [10,11,17,19] could be overestimated from use of multifrequency transducer set at relativity high frequency (5 MHz) that increases the echogenicity of the structures in the superficial field, making the liver more echogenic in comparison to the kidney. The correlation between BLP of moderate or marked grade and LS showed a high specificity and a relatively high sensitivity (96 and 72 %, respectively) for LS [30 % and a high specificity and a low sensitivity (100 and 43 %, respectively) for all grades of LS.…”

Section: Resultscontrasting

confidence: 79%

“…LS has been recognized by a BLP in 1979 [26]. Some authors consider this pattern as highly correlated with LS [6,7,9,10,12,13], especially if associated with a posterior beam attenuation and/or skip areas [10]. Nevertheless, other authors think that BLP might also indicate liver fibrosis [13,[17][18][19][20].…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, the ability of ultrasound to evaluate the presence and degree of LS remains debatable. In fact, although some authors have shown that the bright liver echo pattern (BLP) is strongly correlated with the diagnosis of hepatic steatosis [6][7][8][9][10][11][12][13], other authors think that this pattern is non-specific because the liver echogenicity on ultrasonography also increases with liver fibrosis [14][15][16][17][18][19][20]. Recently, the simultaneous presence of BLP, posterior attenuation, and/or areas with different patterns of fat infiltration (so-called skip areas) around gallbladder or near the portal vein [21] have been identified as distinctive signs of steatosis involving a number of hepatocytes in a microscopic field [30 % [11].…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

Loy¹,

Serra

Chessa

2014

J Ultrasound

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Purpose To evaluate the prevalence of bright liver echo pattern (BLP) on ultrasonography and its correlation with liver steatosis (LS), and fibrosis in patients with chronic hepatitis C. The usefulness of detecting skip areas for steatosis diagnosis has also been evaluated. Methods The study included 88 patients with chronic hepatitis C (55 men, 33 women, average age 45.7 ± 11.2 years). Ultrasound examination was performed in all patients before liver biopsy. The presence of BLP was assessed and graded from 1 to 3. Hypoechogenic areas (skip areas) around the gallbladder or near the portal vein were also evaluated. Hepatic fibrosis was assessed using the Ishak fibrosis score. Steatosis was graded as follows: 1, 2, 3 (\30, 30-70, [70 % of hepatocytes affected, respectively). Results Fifty-three of the 88 patients (60 %) showed BLP (40 grade 1, 13 grades 2 or 3). Skip areas were found in 14 patients (16 %). Histological steatosis was observed in 40 patients (45 %) and in 10 of them (25 %) was grades 2 and 3 (4 and 6 patients, respectively). As regards fibrosis, 2 patients showed F0, 34 F1, 28 F2, 20 F3, 4 F4, none of them F5 and F6. BLP of grades 2 or 3 and presence of skip areas were strongly correlated with LS (P = 0.00007 and P = 0.00003, respectively). No correlation was found between BLP and fibrosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of BLP for LS were 75, 50, 56, 68 and 61 %, respectively. When BLP of grades 2 and 3 and LS of 30 % or more were correlated, the sensitivity, specificity, PPV, NPV and accuracy of BLP were 72, 96, 61, 96 and 90 %, respectively. As regards skip areas the sensitivity, specificity, PPV, NPV and accuracy for LS were 35, 100, 100, 64 and 70 %, respectively. Conclusions In a well-defined group of patients with chronic hepatitis C, the detection of BLP grades 2 and 3 has a good sensitivity and high specificity for high grades of steatosis. A high specificity but low sensitivity for liver steatosis was also found for skip areas, whereas mild fibrosis does not seem to correlate with the hyperechogenicity of the liver.Keywords Liver steatosis Á Ultrasonography Á Bright liver echo pattern Á Skip areas Á Chronic hepatitis C Riassunto Scopo Scopo del lavoro é stato quello di valutare la prevalenza del ''bright liver echo pattern'' (BLP) all'ultrasonografia e la sua correlazione con la steatosi epatica (SE) e la fibrosi in un gruppo di pazienti con epatite cronica C. E' stata valutata anche l'utilità della determinazione delle cosiddette ''aree di risparmio'' per la diagnosi di steatosi. Metodi Lo studio ha incluso 88 pazienti con epatite cronica C (55 di sesso maschile, 33 di sesso femminile; età media 45.7 ± 11.2 anni). L'esame ultrasonografico é stato eseguito in tutti i pazienti prima di effettuare la biopsia epatica. La presenza di BLP é stata graduata da 1 a 3. É stata anche valutata la presenza o meno di aree ipoecogene (cosiddette ''aree di risparmio''), adiacenti alla colecisti o in sede parailare epatic...

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Section: Resultscontrasting

confidence: 79%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

Loy¹,

Serra

Chessa

2014

J Ultrasound

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“…An ultrasonographic diagnosis of fatty liver was defined as the presence of a diffuse increase of fine echoes in the liver parenchyma compared with the kidney or spleen parenchyma. 20 Ultrasonographic diagnoses of fatty liver were determined by radiologists using liver images.…”

Section: Measurementsmentioning

confidence: 99%

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men

et al. 2011

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OBJECTIVES: Although the existence of metabolically healthy obese (MHO) individuals has been recognized, little is known regarding metabolic health status in these subjects over time. Thus, we evaluated longitudinal changes in metabolic parameters among MHO subjects compared with metabolically healthy, normal-weight (MHNW) subjects. METHODS: A cohort study was performed on 2599 Korean men, 30 --59 years of age, with no evidence of fatty liver disease on ultrasound and no traits of metabolic syndrome at baseline. BMI was categorized based on criteria for Asian population. Study participants were followed annually or biennially between 2002 and 2009. At each visit, the fatty liver on ultrasound was assessed and metabolic abnormalities were measured. Parametric Cox models and a pooled logistic regression models were used to evaluate the relationships of BMI with incident metabolic abnormalities. RESULTS: During 9647.1 person-years of follow-up, 1673 participants developed metabolic abnormalities. After adjusting for age, smoking, alcohol intake and exercise, higher baseline BMI categories predicted increased incidences of metabolic abnormalities in a dose-response manner. The hazard ratios (95% confidence intervals) for hypertriglyceridemia, prediabetes, pre-hypertension, low high-density lipoprotein-cholesterol, fatty liver, elevated high sensitivity-C reactive protein, elevated homeostasis model assessment of insulin resistance, any metabolic abnormality and metabolic syndrome among the MHO subjects compared with the MHNW subjects were 1.51 (1. Keywords: body mass index; risk factors; insulin resistance; metabolic syndrome X; follow-up studies INTRODUCTIONObesity is a risk factor for cardiometabolic disorders such as type 2 diabetes mellitus and cardiovascular disease. 1,2 However, the incidence of obesity-related metabolic disturbances varies widely among obese individuals. 3,4 A unique subset of obese individuals that appears to be protected from obesity-related metabolic abnormalities has been identified. 3,5 These individuals, referred to as metabolically healthy but obese (MHO), are relatively insulin sensitive and have a favorable cardiovascular risk profile despite excessive body fat. 6 Previous studies indicate that MHO individuals, regardless of body mass index, are not at increased risk for cardiovascular diseases compared with normal-weight subjects without insulin resistance. 7,8 Therefore, weight loss may not be deemed necessary among these individuals.Recent longitudinal studies have observed that obese men without metabolic syndrome were at an increased risk for cardiovascular events or death compared with normal-weight individuals without metabolic syndrome. 9,10 Other studies observed that the MHO subset had an intermediate cardiovascular risk between healthy non-obese subjects and insulin resistant subjects. 11,12 Furthermore, recent intervention studies showed that lifestyle-induced weight loss among MHO individuals was associated with improved insulin sensitivity. 13,14

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“…The degree of steatosis is commonly assessed by visually and semiquantitatively estimating the area of the section of a needle biopsy that is occupied by fat vacuoles. 1 The result is often expressed as 'the percent of hepatocytes in the biopsy involved' and can be 0-3 where 0 is none, 1 is up to 33%, 2 is 33-66% and 3 is 466% 2 and such grading is also recommended by the American Gastroenterological Association when assessing nonalcoholic fatty liver disease. 3 However, it should be pointed out that actual counting of hepatocytes with fat vacuoles is not performed and that the basis of the grading is the estimated area of fat vacuoles (Brunt EM, 2003, personal communication).…”

mentioning

confidence: 99%

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

et al. 2005

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The degree of steatosis in liver biopsies is usually assessed by a morphological semiquantitative approach in which the histopathologist uses a four-graded scale: 0-3 or none, slight, moderate and severe. Scores 1-3 are considered to correspond to fat deposition in o33, 33-66 and 466% of the hepatocytes. There is a considerable inter-and intra-individual variation in such scoring methods and a more standardized and quantitative approach is preferable. In the present study, we compare the semiquantitative technique with the stereological point counting method in the assessment of hepatic steatosis. A total of 75 archived liver needle biopsies were used. They were selected according to the original routine diagnosis of slight, moderate or severe steatosis. In all, 10 randomly selected images from each biopsy were digitized into a computer, a point grid lattice was superimposed and the number of hits on fat globules was counted. A pathologist scored the specimens in a four-graded scale as described above. The mean liver biopsy area (volume) with fat in hepatocytes was 2.2% for grade 1, 9.2% for grade 2 and 23.1% for grade 3. The kappa value for the semiquantitative estimates was 0.71 for the unweigthed kappa and 0.87 for weighted kappa. The intraclass correlation coefficient (ICC) was 0.99 for images counted twice and 0.95 when two sets of images were captured from the same biopsy. These ICCs indicate excellent agreement and above that of the semiquantitative estimates. In conclusion, the area/volume of fat content of the hepatocytes is greatly overemphasized in semiquantitative estimation. Furthermore, the point counting technique has a better reproducibility than visual evaluation and should be preferred in estimates of liver steatosis in scientific studies and in clinical contexts when the amount of steatosis is important for treatment and prognosis, such as liver transplantation. Modern Pathology (2005) 18, 912-916.

show abstract

Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases

Cited by 309 publications

References 7 publications

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

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