Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading

Needleman, Laurence; Kurtz, A B; Rifkin,; Cooper, HS; Pasto, M E; Goldberg, B. B.

doi:10.2214/ajr.146.5.1011

Cited by 187 publications

(120 citation statements)

References 13 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%

“…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]. In this study, the prevalence of BLP, its correlation with LS and fibrosis, and the utility of detecting BLP and skip areas for LS diagnosis were evaluated in a group of patients with chronic hepatitis C. Considering that steatosis, a frequent feature of chronic hepatitis C [27,28,30], is associated with progression of chronic HCV-related liver disease [24,[30][31][32][33][34], we thought that establishing a correlation between sonographic findings and LS could be of great usefulness in the management of these patients.…”

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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“…Portal venous flow is classically described as being continuous in healthy subjects (Needleman et al 1986). In normal adults, the VPI is 0.48 (Gallix et al 1997).…”

Section: Discussionmentioning

confidence: 99%

Portal Vein Hemodynamics in Patients with Non-Alcoholic Fatty Liver Disease

Erdoğmuş

Tamer

Büyükkaya

et al. 2008

Tohoku J. Exp. Med.

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Paralleling the rise in the incidence of obesity and diabetes worldwide, nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as one of the major causes of chronic liver disease. Doppler sonography is used as a diagnostic method in the non-invasive assessment of the hemodynamics of hepatic vascular flow in liver diseases. We investigated the effects of fatty infiltration in the liver on the Doppler flow hemodynamics of the portal vein. Doppler sonography of the liver and portal vein was performed in 60 subjects with NAFLD and 20 healthy volunteers (control). The patients were grouped into mild (grade 1), moderate (grade 2), and severe (grade 3) according to sonographic appearance of hepatosteatosis (n = 20 for each group). The vein pulsatility index (VPI), mean flow velocity (MFV), peak maximum velocity (V max ), and peak minimum velocity (V min ) of the portal vein were significantly lower in patients with NAFLD than those of the controls ( p < 0.001). The VPI was 0.20 in the patients and 0.31 in the control. The MFV was 12.3 cm/sec in the patients and 16.5 cm/sec in the control group. The portal vein flow was found to be decreased as the grade of fatty infiltration increased for VPI (r = -0.946, p < 0.001), MFV (r = -0.951, p < 0.001). The alteration in Doppler waveform pattern of portal vein with fatty liver population suggests reduced vascular compliance in the liver. doppler sonography; nonalcoholic fatty liver; portal vein pulsatility; hepatosteatosis; liver. Tohoku J. Exp. Med., 2008, 215 (1), 89-93.

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“…1,10,15,[19][20][21][22] Among these criteria, deep-beam attenuation has presented better performance for diagnosing fatty liver disease. [25][26][27][28][29][30][31] However, conventional B-mode ultrasonography presents limitations, including subjective evaluation and operator dependency. Therefore, inclusion of a new biometric parameter, i.e.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

et al. 2015

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CONTEXT AND OBJECTIVE: Noninvasive strategies for evaluating non-alcoholic fatty liver disease (NAFLD) have been investigated over the last few decades. Our aim was to evaluate the diagnostic accuracy of a new hepatic ultrasound score for NAFLD in the ELSA-Brasil study. DESIGN AND SETTINGS: Diagnostic accuracy study conducted in the ELSA center, in the hospital of a public university. METHODS: Among the 15,105 participants of the ELSA study who were evaluated for NAFLD, 195 individuals were included in this sub-study. Hepatic ultrasound was performed (deep beam attenuation, hepatorenal index and anteroposterior diameter of the right hepatic lobe) and compared with the hepatic steatosis findings from 64-channel high-resolution computed tomography (CT). We also evaluated two clinical indices relating to NAFLD: the fatty liver index (FLI) and the hepatic steatosis index (HSI). RESULTS: Among the 195 participants, the NAFLD frequency was 34.4%. High body mass index, high waist circumference, diabetes and hypertriglyceridemia were associated with high hepatic attenuation and large anteroposterior diameter of the right hepatic lobe, but not with the hepatorenal index. The hepatic ultrasound score, based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe, presented the best performance for NAFLD screening at the cutoff point

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Sonography of diffuse benign liver disease: accuracy of pattern recognition and grading

Cited by 187 publications

References 13 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

Portal Vein Hemodynamics in Patients with Non-Alcoholic Fatty Liver Disease

Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

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