TY - JOUR
T1 - Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients
AU - Bril, Fernando
AU - Ortiz-Lopez, Carolina
AU - Lomonaco, Romina
AU - Orsak, Beverly
AU - Freckleton, Michael W
AU - Chintapalli, Kedar N
AU - Hardies, Jean
AU - Lai, Song
AU - Solano, Felipe
AU - Tio, Fermin
AU - Cusi, Kenneth
N1 - Publisher Copyright:
© 2015 John Wiley & Sons A/S.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - 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 (1H-MRS) and histology. Methods: We recruited 146 patients and performed: a liver US using a 5-parameter scoring system, a liver 1H-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 1H-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 1H-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 1H-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.
AB - 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 (1H-MRS) and histology. Methods: We recruited 146 patients and performed: a liver US using a 5-parameter scoring system, a liver 1H-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 1H-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 1H-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 1H-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.
KW - Hepatic steatosis
KW - NAFLD
KW - NASH
KW - Obesity
KW - Steatohepatitis
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U2 - 10.1111/liv.12840
DO - 10.1111/liv.12840
M3 - Article
C2 - 25847730
AN - SCOPUS:84938976092
SN - 1478-3223
VL - 35
SP - 2139
EP - 2146
JO - Liver International
JF - Liver International
IS - 9
ER -