The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis

Palmentieri, Bruno; Sio, Ilario de; Mura, Vincenzo La; Masarone, Mario; Vecchione, Raffaella; Bruno, Savino; Torella, Roberto; Persico, Marcello

doi:10.1016/j.dld.2006.03.021

Cited by 298 publications

(225 citation statements)

References 21 publications

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“…No correlation between BLP and fibrosis has been found. These data are in agreement with those recently reported by other authors [11], although they must be confirmed on wider groups including patients with higher levels of fibrosis than those included in our study.…”

Section: Resultssupporting

confidence: 94%

“…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%

“…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: Resultssupporting

confidence: 94%

Section: Resultscontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Several studies have assessed the sensitivity and specifi city of ultrasound for detecting LS. In these studies, the sensitivity ranged from 60% to 94% and the specifi city from 84% to 97% [21][22][23][24] . In a sample of 94 Brazilian individuals with elevated ALT, 40% presented LS on ultrasound, and both the BMI and history of diabetes were independently associated with the presence of LS 25 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

Nau

Soares

Shiozawa

et al. 2014

Rev. Soc. Bras. Med. Trop.

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“…), blinded to the clinical data, using a 3.75 MHz convex transducer (Toshiba Power vision 6000, Toshiba, Rome, Italy). The diagnosis of liver steatosis was made on the basis of echographic liver features 22 as follows: (1) liver hyperechogenicity relative to adjacent right kidney or spleen, (2) unclear display of intra-hepatic lacuna structures, (3) mild to moderate hepatomegaly with a round and blunt border and (4) unclear display of envelop of right liver lobe and diaphragm. Liver steatosis was graded as mild, moderate and severe.…”

Section: Patientsmentioning

confidence: 99%

Metformin versus dietary treatment in nonalcoholic hepatic steatosis: a randomized study

et al. 2010

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Objective: We aimed at evaluating whether the addition of low-dose metformin to dietary treatment could be an effective approach in nondiabetic patients with nonalcoholic fatty liver disease (NAFLD). Methods: We carried out a 6-month prospective study in a series of overweight or obese patients with ultrasonographic diagnosis of hepatic steatosis. In total, 50 patients were enrolled and randomized into two groups: the first group (n ¼ 25) was given metformin (1 g per day) plus dietary treatment and the second group (n ¼ 25) was given dietary treatment alone. Results: At the end of the study, the proportion of patients with echographic evidence of fatty liver was reduced in both the metformin (Po0.0001) and the diet group (P ¼ 0.029). Moreover, patient body mass index and waist circumference significantly decreased in both groups (Po0.001). Fasting glucose, insulin resistance (evaluated as homeostasis model assessment of insulin resistance (HOMA-IR)) and serum adiponectin decreased in both groups, although these changes reached statistical significance only in the metformin group. In this group, HOMA-IR decreased from 3.3±1.6 to 2.4±1.2 (P ¼ 0.003), whereas it decreased from 3.2 ± 1.6 to 2.8 ± 1.1 (not significant, NS) in the diet group. Similarly, the proportion of patients with impaired fasting glucose declined from 35 to 5% (P ¼ 0.04) in the metformin and from 32 to 12% (NS) in the diet group. At baseline, B40% of patients in both groups met the diagnostic criteria of metabolic syndrome. This proportion decreased to 20% in the metformin group (P ¼ 0.008) and to 32% in the diet group (NS). Conclusions: In our 6-month prospective study, both low-dose metformin and dietary treatment alone ameliorated liver steatosis and metabolic derangements in patients with NAFLD. However, metformin was more effective than dietary treatment alone in normalizing several metabolic parameters in these patients.

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The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis

Cited by 298 publications

References 21 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

Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

Metformin versus dietary treatment in nonalcoholic hepatic steatosis: a randomized study

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