Hypoechoic lesions in the ‘bright liver': A reliable indicator of fatty change. A prospective study (original) (raw)
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The role of ulTrasound evaluaTion in The diagnosis of faTTy liver – is an accuraTe sTaging possible?
This paper presents the results from a research study which examines the correlations between the biological and morphopathological evaluation of the fatty liver and the ultrasound investigation. The purpose is to establish the utility and accuracy of ultrasound evaluation of fatty liver and to suggest an ultrasound staging of hepatic steatosis. Material and method: we evaluated 2 groups of patients -group A: 222 patients examined using ultrasound and liver biopsy and group B: 167 patients examined using ultrasound and steatotest. The obtained results demonstrate that the echographic evaluation is a reliable diagnostic method for liver steatosis, with over 0,82 sensitivity and over 0,90 specificity, depending on the steatosis stage.
Efficacy of Ultrasonography as a tool for detection of Fatty Liver
Background: Fatty liver is a common clinical condition which is fast assuming importance as a possible precursor of more serious liver disorders including cirrhosis of liver and hepatocellular carcinoma. Aim: The present study was performed to evaluate the efficacy of ultrasonography for diagnosis of fatty liver. Methods: The ultrasonographic study data and histological data of all patients undergoing liver biopsy in the Gastroenterology Department of S.C.B.Medical College, Cuttack was analysed to evaluate the efficacy of ultrasonography in detecting fatty liver disease. Results: The subjects included 31 consecutive persons who underwent liver biopsy for evaluation of either fatty liver or raised transaminases. Fatty liver was diagnosed by ultrasonography in 25 of the 31 patients who underwent liver biopsy. All 25 patients with sonographic fatty liver had fatty liver on histology, while histology did not reveal fatty infiltration in any of the 6 patients in whom sonology did not reveal fatty liver. Thus the sensitivity and specificity of sonology for detecting fatty liver was found to be 100%. Conclusions: Ultrasonology is highly sensitive and specific for diagnosis of fatty liver. Hence ultrasonology which is noninvasive and safe can be used to study the prevalence of fatty liver in the asymptomatic general population.
Diagnosis of fatty liver disease
European Journal of Gastroenterology & Hepatology, 2003
Non-alcoholic fatty liver disease is increasingly being recognized as an important and common condition, affecting approximately 20% of the general population. Although liver biopsy is currently the gold standard for diagnosis, there is a need for less invasive methods. Imaging by ultrasound, computerized tomography and magnetic resonance are all able to demonstrate fat. In this paper, these three imaging techniques are critically assessed. Ultrasound, although probably not the most reliable imaging method, has many advantages and, when positive, gives a high degree of certainty of the diagnosis depending on the prevalence of fatty liver in the population being studied. Unlike liver biopsy, none of these techniques is able to differentiate simple steatosis from non-alcoholic steatohepatitis.
European Radiology, 2007
The objective of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) to characterize hypoechoic focal hepatic lesions (HFHL) in fatty liver (FL). A study group of 105 patients with FL and 105 HFHLs (52 malignant and 53 benign) underwent CEUS after SonoVue administration. Two blinded readers independently reviewed baseline ultrasound (US) and CEUS scans and classified each lesion as malignant or benign on a five-point scale of confidence, and recorded whether further imaging work-up was needed. Sensitivity, specificity, areas under the receiver operating characteristic (ROC) curve (A z ), and interobserver agreement were calculated. We observed that the diagnostic confidence improved after reviewing CEUS scans for both readers (A z =0. 706 and 0.999 and A z =0.665 and 0.990 at baseline US and CEUS, respectively; p<0.0001). Inter-reader agreement increased (weighted k=0.748 at baseline US vs. 0.882 at CEUS). For both readers, after CEUS, the occurrence of correctly characterized lesions increased (from 27/105 [27.5%] to 94/105 [89.5%], and from 19/105 [18.1%] to 93/105 [88.6%], respectively; p<0.0001) and the need for further imaging decreased (from 93/105 [88.6%] to 26/105 [24.8%], and from 96/105 [91.4%] to 40/105 [38.1%], respectively; p<0.0001). We conclude that CEUS improves the diagnostic performance of radiologists in the characterization of HFHLs in FL and reduces the need for further imaging work-up.
Hepatology, 2011
Ultrasonography is a widely accessible imaging technique for the detection of fatty liver, but the reported accuracy and reliability have been inconsistent across studies. We aimed to perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. We used MEDLINE and Embase from October 1967 to March 2010. Studies that provided cross-tabulations of ultrasonography versus histology or standard imaging techniques, or that provided reliability data for ultrasonography, were included. Study variables were independently abstracted by three reviewers and double checked by one reviewer. Forty-nine (4720 participants) studies were included for the meta-analysis of diagnostic accuracy. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Conclusion: Ultrasonography allows for reliable and accurate detection of moderate-severe fatty liver, compared to histology. Because of its low cost, safety, and accessibility, ultrasound is likely the imaging technique of choice for screening for fatty liver in clinical and population settings. (HEPATOLOGY 2011;54:1082-1090
Metabolism, 2017
Background and Aims: Fatty liver is a common feature of different types of liver diseases. The sensitivity and specificity of ultrasonography for diagnosing fatty liver is variable. A semiquantitative ultrasound score, i.e. the ultrasonographic fatty liver indicator (US-FLI), is closely associated with metabolic/histological variables in patients with nonalcoholic fatty liver disease (NAFLD). The main aims of this study were to assess the diagnostic performance of US-FLI in detecting varying degrees of histological steatosis, and to examine the association of US-FLI with metabolic/histological parameters in 352 biopsied patients with various chronic liver diseases (173 with hepatitis C [HCV], 23 with hepatitis B [HBV], 123 with NAFLD and 33 with other etiologies). Results: US-FLI accurately detected mild steatosis (minimum amount 10% on histology) with a cutoff value ≥2 (sensitivity 90.1%, specificity 90%), moderate steatosis (≥30%) with a cutoff value ≥3 (sensitivity 86.4%, specificity 92.5%) and severe steatosis (>66%) with a cutoff value ≥5 (sensitivity 88.5%, specificity 87%). US-FLI was correlated to steatosis percentage in each liver disease group as well as to lobular inflammation, ballooning, portal fibrosis, grading and staging in patients with NAFLD or HCV. US-FLI was also correlated to waist circumference, body mass index and insulin resistance both in the whole sample and in each liver disease group. Conclusions: US-FLI accurately identifies histological severity and is correlated to metabolic parameters in patients with various steatogenic liver diseases. US-FLI is an easy and versatile tool for the screening of steatosis and the metabolic health of these patients.
Hypoechoic focal liver lesions: characterization with contrast enhanced ultrasonography
Journal of Clinical …, 2005
Purpose. To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions. Methods. We studied 88 hypoechoic liver lesions (diameter range, 1-18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (US) with contrast-enhanced ultrasonography (CEUS). Final diagnosis was made using contrast enhanced helical CT, contrast enhanced MR, angiography (DSA), and/or histopathic confirmation or clinical imaging follow-up. Results. There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (FNH), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. Malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (HCC) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (CCC) and 1 non-Hodgkin's lymphoma (NHL). CEUS characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. On the basis of the results obtained during the sinusoidal contrast enhanced phase of CEUS, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. The enhancement pattern of 13 small (< or ¼ 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 FNHs, 4 HCCs, 4 metastatic endocrine tumors) was better demonstrated on CEUS than on helical CT. In these cases the hyper vascularization of the lesions shown on CEUS was not confirmed on CT. Conclusions. CEUS distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%.
Radiologic evaluation of nonalcoholic fatty liver Disease
Medical Journal of Viral Hepatitis
Nonalcoholic Fatty Liver Disease (NAFLD) is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. NAFLD comprises a range of liver conditions varying in severity of hepatocytes injury and resulting fibrosis-cirrhosis risk. Among these, hepatic steatosis (fatty liver) is referred to as NAFL, and nonalcoholic fatty liver (NAFL) is defined as a more grave process with both fat and inflammation in the liver that over time can cause liver cirrhosis (steatohepatitis). Liver biopsy is the gold standard method to differentiate, whether the patient with fatty liver has only steatosis, or NASH. Unfortunately, liver biopsy has well-known limitations (invasiveness and sampling variability) and cannot be proposed for all patients, especially given the high prevalence of NAFLD worldwide. This review discuss the radiologic evaluation of liver steatosis and fibrosis for patients with NAFLD.