Elsevier

Journal of Hepatology

Volume 51, Issue 6, December 2009, Pages 1061-1067
Journal of Hepatology

Validity of real time ultrasound in the diagnosis of hepatic steatosis: A prospective study☆

https://doi.org/10.1016/j.jhep.2009.09.001Get rights and content

Background/Aims

Ultrasound is used to screen for hepatic steatosis, the most common liver disease in the United States. However, few studies have prospectively evaluated the accuracy of ultrasound to diagnose hepatic steatosis. Therefore, a double blinded prospective study was performed in consecutive patients undergoing liver biopsy to evaluate the accuracy of ultrasound to diagnose hepatic steatosis.

Methods

Real time ultrasound was performed just prior to the biopsy by a single investigator masked to the clinical diagnosis. The liver biopsy was reviewed by a pathologist masked to the clinical indication or sonographic findings.

Results

Of 73 consecutive patients studied, macrovesicular steatosis of any severity on biopsy was found in 46 (63%) and micro vesicular fat found in 51 (69.9%). The overall impression of the sonographer for the presence of macrovesicular hepatic steatosis of any degree had a sensitivity of 60.9% and a specificity of 100%. The sensitivity increased to 100% and the specificity to 90% when there was ⩾20% of fat. The zonular distribution of the fat did not alter the diagnostic accuracy of ultrasound. Ultrasound had a poor yield in the diagnosis of microvesicular fat with an overall sensitivity of 43% and a specificity of 73%. The combination of increased echogenicity and portal vein blurring on ultrasound had the greatest sensitivity in the diagnosis of hepatic steatosis.

Conclusion

Real time ultrasound using a combination of sonographic findings has a high specificity but underestimates the prevalence of hepatic steatosis when there is < 20% fat.

Section snippets

1. Introduction

Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease in the United States [1], [2], [3]. The diagnosis of NAFLD is established by liver biopsy but ultrasound (US) is being increasingly recognized as a screening tool due to the useful information obtained as well as being non-invasive, well tolerated and widely available [4]. Hepatic steatosis appears as a diffuse increase in echogenicity (bright liver) and a number of sonographic alterations in the liver [5], [6].

2. Patients and methods

Seventy-five consecutive patients undergoing an elective liver biopsy for clinical indications of abnormal liver function or clinical suspicion of liver disease being performed in the Gastroenterology division of Metro Health Medical Center, Cleveland, OH had a real time US by a single investigator (SD) masked to the clinical indication for the liver biopsy as part of confirmation of the site of the biopsy just prior to the procedure. All patients were determined to have normal renal function

3. Results

The clinical and demographic findings of the patients are shown in Table 1. As shown the most common indications for the biopsy were either fatty liver or hepatitis C. There were 4 patients with cirrhosis of the liver. None of the patients had significant alcohol consumption in the 6 months prior to the biopsy. History of significant alcohol consumption over 6 months prior to the biopsy was observed in 8 patients (7 patients with HCV and 1 cirrhotic patient). On histology, macrovesicular

4. Discussion

With the increasing recognition of NAFLD as being the most common cause of chronic liver disease, ultrasound is likely to become the screening modality of choice before a confirmatory liver biopsy is performed. Previous studies on the diagnostic accuracy of ultrasound for identification of hepatic steatosis have been either retrospective or performed in patients with documented fatty liver [26], [27]. We report the diagnostic accuracy of each of the sonographic criteria used to document hepatic

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    ☆

    The underlying research reported in the study was funded in part by the NIH Institutes of Health, Grant No. U DK 61732. The authors who have taken part in this study declared that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.

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    Copyright © 2009 European Association for the Study of the Liver. Published by Elsevier Ireland Ltd. All rights reserved.