Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases

doi:10.1016/S1590-8658(02)80111-6

Digestive and Liver Disease

Volume 34, Issue 7, July 2002, Pages 516-522

https://doi.org/10.1016/S1590-8658(02)80111-6 Get rights and content

Abstract

Aims. To investigate whether hyperechogenicity of liver can reliably be interpreted as liver steatosis and if any concomitant or isolated fibrosis can be disclosed.

Patients and methods. A series of 165 patients with no signs or symptoms of liver disease referred because of slightly to moderately raised aminotransferases (alanine aminotransferase and/or aspartate aminotransferase 0.7–5.0 μkat/l) for more than 6 months were prospectively investigated with a comprehensive laboratory profile, ultrasound examination of liver and percutaneous liver biopsy. Fibrosis was assessed quantitatively and according to Metavir. Steatosis was graded as none, mild, moderate or severe.

Results. Of 98 (59.4%) patients with raised echogenicity 85 (86.7%) had liver steatosis of at least moderate degree, 9 patients with same degree of steatosis had normal echogenicity and 13 patients with no or only mild steatosis had a hyperechogenic liver (sensitivity 0.90, specificity 0.82, positive predictive value 0.87, negative predictive value 0.87). About the same relations were found regardless of body mass index and degree of fibrosis. With increased echogenicity together with high attenuation (n=59) and reduced portal vessel wall distinction (n=79), positive predictive value increased to 0.93 and 0.94, respectively. Quantitatively assessed fibrosis (mean ± SD) was 3.2±4.6% of biopsy area with normal and 2.3±1. 8% with raised echogenicity (ns). Echogenicity was normal in 5 out of 9 patients with septal fibrosis and in 4 out of 6 patients with cirrhosis. Any structural, non-homogenous findings at ultrasound were not associated with architectural fibrotic changes and none had nodular contours of liver surface.

Conclusions. Assessment of liver echogenicity is of value for detection or exclusion of moderate to pronounced fatty infiltration (correct classification 86.6%) but cannot be relied upon in diagnosing fibrosis, not even cirrhosis in asymptomatic patients with mild to moderately elevated liver transaminases.

References (12)

A.E.A. Joseph et al.
Ultrasound in the assessment of diffuse parenchymal liver disease
Clin Radiol
(1991)
A.E.A. Joseph et al.
Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease
Clin Radiol
(1991)
C. Aubé et al.
Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis
J Hepat
(1999)
N.L. Sandford et al.
Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?
Gastroenterology
(1986)
S.H. Saverymuttu et al.
Ultrasound scanning in the detection of hepatic fibrosis and steatosis
Br Med J
(1986)
U.L. Mathiesen et al.
The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients
Scand J Gastroenterol
(1999)

There are more references available in the full text version of this article.

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Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases

Abstract

Clin Radiol

Clin Radiol

J Hepat

Is ultrasonography useful in the assessment of diffuse parenchymal liver disease?

Gastroenterology

Ultrasound scanning in the detection of hepatic fibrosis and steatosis

Br Med J

The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients

Scand J Gastroenterol