The accuracy of the report of hepatic steatosis on ultrasonography in patients infected with hepatitis C in a clinical setting: A retrospective observational study

Abstract

Background: Steatosis is occasionally reported during screening ultrasonography in patients with hepatitis C virus (HCV). We conducted a retrospective observational study to assess the factors associated with steatosis on ultrasonography and the relationship between steatosis on ultrasound versus biopsy in patients infected with HCV in a clinical setting. Our hypothesis was ultrasonography would perform poorly for the detection of steatosis outside of the context of a controlled study, primarily due to false-positive results caused by hepatic fibrosis and inflammation.

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

“…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.…”

“…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.…”

“…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].…”

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

“…In this case, sensitivity and specificity of US in the diagnosis of steatosis was 49.1% and 75%, respectively [6] . These values are also demonstrated (sensitivity: 43%; specificity: 79%) for the diagnosis hepatic steatosis in patients infected with hepatitis C virus [10] . Several hypotheses may explain this low performance of US in severe obese people.…”

Noninvasive imaging assessment of non-alcoholic fatty liver disease: Focus on liver scintigraphy

“…de Moura Almeida et al [15] found a sensitivity of 64.9% using US for the diagnosis of hepatic steatosis in 105 severely obese patients. The presence of underlying chronic liver diseases can also reduce the accuracy of US in the diagnosis of hepatic steatosis, as hepatic fibrosis can increase liver echogenicity [16] . Another limitation of US is that it cannot be used to quantify the amount of fat or provide a differential diagnosis between simple steatosis and NASH.…”