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Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients
Author(s) -
Bril Fernando,
OrtizLopez Carolina,
Lomonaco Romina,
Orsak Beverly,
Freckleton Michael,
Chintapalli Kedar,
Hardies Jean,
Lai Song,
Solano Felipe,
Tio Fermin,
Cusi Kenneth
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12840
Subject(s) - medicine , nonalcoholic fatty liver disease , liver biopsy , fatty liver , overweight , histology , steatosis , gastroenterology , liver disease , magnetic resonance imaging , biopsy , radiology , obesity , disease
Background & Aims Liver ultrasound ( US ) is usually used in the clinical setting for the diagnosis and follow‐up of patients with nonalcoholic fatty liver disease ( NAFLD ). However, no large study has carefully assessed its performance using a semiquantitative ultrasonographic scoring system in overweight/obese patients, in comparison to magnetic resonance spectroscopy ( 1 H‐ MRS ) and histology. Methods We recruited 146 patients and performed: a liver US using a 5‐parameter scoring system, a liver 1 H‐ MRS to quantify liver fat content, and a liver biopsy to assess histology. All measurements were repeated in a subgroup of patients ( n = 62) after 18 months of follow‐up. Results The performance of liver US (parenchymal echo alone) was rather modest, and significantly worse than 1 H‐ MRS ( AUROC : 0.82 [0.69–0.94] vs. 0.96 [0.90–1.00]; P = 0.04). However, the AUROC improved when different echographic parameters were taken into account ( AUROC : 0.89 [0.83–0.96], P = 0.15 against 1 H‐ MRS ). Optimum sensitivity for liver US was achieved at a liver fat content ≥12.5%, suggesting that below this threshold, liver US is less sensitive. Liver 1 H‐ MRS showed a high accuracy for the diagnosis of NAFLD , and correlated strongly with histological steatosis ( r = 0.73, P < 0.0001). None of the imaging tests was adequate enough to predict changes over time in histology. Conclusions Despite its widespread use, liver US has several important limitations that healthcare providers should recognize, particularly because of its low sensitivity. Using a combination of echographic parameters, liver US showed a significant improvement in its diagnostic performance, but still was of limited value for monitoring treatment over time.