The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis

Abstract

ObjectiveTo meta-analyse the diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis.MethodsFrom a comprehensive literature search in MEDLINE, EMBASE, CINAHL and Cochrane (up to November 2009), articles were selected that investigated the diagnostic performance imaging techniques for evaluating hepatic steatosis with histopathology as the reference standard. Cut-off values for the presence of steatosis on liver biopsy were subdivided into four groups: (1) >0, >2 and >5% steatosis; (2) >10, >15 and >20%; (3) >25, >30 and >33%; (4) >50, >60 and >66%. Per group, summary estimates for sensitivity and specificity were calculated. The natural-logarithm of the diagnostic odds ratio (lnDOR) was used as a single indicator of test performance.Results46 articles were included. Mean sensitivity estimates for subgroups were 73.3–90.5% (US), 46.1–72.0% (CT), 82.0–97.4% (MRI) and 72.7–88.5% (1H-MRS). Mean specificity ranges were 69.6–85.2% (US), 88.1–94.6% (CT), 76.1–95.3% (MRI) and 92.0–95.7% (1H-MRS). Overall performance (lnDOR) of MRI and 1H-MRS was better than that for US and CT for all subgroups, with significant differences in groups 1 and 2.ConclusionMRI and 1H-MRS can be considered techniques of choice for accurate evaluation of hepatic steatosis.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-010-1905-5) contains supplementary material, which is available to authorized users.

Nonalcoholic fatty liver disease is a negative risk factor for prostate cancer recurrence

“…Furthermore, without liver biopsy, it is impossible to characterize liver histology such as degree of fibrosis and distinguish between nonalcoholic fatty liver and nonalcoholic steatohepatitis because nonalcoholic steatohepatitis can progress to cirrhosis, liver failure, and liver cancer and increase hepatic and extrahepatic morbidity and mortality (Chalasani et al 2012). However, a meta-analysis from 46 articles comparing various imaging modalities to liver biopsy for diagnosis of NAFLD concluded that mean sensitivity estimates for US and CT were 73.3-90.5 and 46.1-72.0%, respectively, and mean specificity range were 69.6-85.2 and 88.1-94.6% respectively (Bohte et al 2011). Specificity, sensitivity, positive predictive value, and negative predictive value of unenhanced CT liver attenuation alone with threshold of 48 HU for diagnosis of NAFLD used in this study were 100, 53.8, 100, and 93.9% respectively; these values are highly specific for diagnosing hepatic steatosis (Pickhardt et al 2012).…”

Hepatic steatosis: correlation of bmi, CT fat measurements and liver density, and biopsy results

“…As such, the macroscopic identification of FLD using non-invasive imaging techniques has been advocated for the diagnosis of nonalcoholic FLD (7). At present, various radiological methods can detect the presence of fat in the liver, including abdominal ultrasound, CT, and MRI (6). Ultrasonography may reveal hyperechoic liver parenchymal echotextures, although this is a non-specific finding (20).…”

US Cannot Be Used to Predict the Presence or Severity of Hepatic Steatosis in Severely Obese Adolescents

“…Serum alanine aminotransferase, however, correlates somewhat with infl ammation, but not with liver steatosis. US, on the other hand, has an adequate diagnostic accuracy for detecting moderate or severe hepatic steatosis in the adult population in general, with pooled sensitivities ranging from 85.7% to 91.1% and pooled specifi cities ranging from 85.2% to 91.9% in a recently published meta-analysis ( 6 ). All data were obtained from studies that compared US with histopathologic evaluation.…”