Gastroenterology

Gastroenterology

Volume 123, Issue 3, September 2002, Pages 745-750
Gastroenterology

Clinical–Liver, Pancreas, and Biliary Tract
The utility of radiological imaging in nonalcoholic fatty liver disease,☆☆

https://doi.org/10.1053/gast.2002.35354Get rights and content

Abstract

Background & Aims: This prospective study evaluates the role of radiological modalities in establishing the diagnosis of nonalcoholic steatohepatitis (NASH). Methods: Consecutive patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) were enrolled (2000–2001). Patients with other liver diseases and significant alcohol consumption (>20 g/day) were excluded. Clinicodemographic data were gathered at the time of liver biopsy. Each biopsy specimen was assessed by a hepatopathologist. Each patient underwent a limited abdominal ultrasonography (US), computerized tomography (CT), and magnetic resonance imaging (MRI). Films were interpreted by a radiologist who used a predetermined radiological protocol. Each radiological study was reread by the same radiologist and a second radiologist. Results: Patients with NASH had greater aspartate aminotransferase levels (P = 0.03), greater ferritin levels (P = 0.05), more hepatocyte ballooning (P < 0.0001), and more fibrosis (P = 0.002). None of the radiological features distinguished between NASH and other types of NAFLD. No radiological modality detected the presence of hepatocyte ballooning, Mallory's hyaline, or fibrosis, which are important features in the diagnosis of NASH. The presence of >33% fat on liver biopsy was optimal for detecting steatosis on radiological imaging. Conclusions: Differences between NASH and nonprogressive NAFLD were not apparent with any radiological modality. Of the pathologic features important for establishing the diagnosis of NASH, only the severity of steatosis was reflected in these radiological modalities. Good intraobserver agreement was evident for each modality (US, CT, and MRI) that was superior to interobserver agreement.

GASTROENTEROLOGY 2002;123:745-750

Section snippets

Patient selection

Consecutive patients with the clinicopathologic diagnosis of NAFLD were invited to participate in the study. After obtaining informed consent, we used the following criteria for patient enrollment: (1) persistently abnormal liver enzyme levels for more than 3 months, (2) findings on liver biopsy consistent with NAFLD according to a previously developed NAFLD pathologic protocol,19 (3) other causes of liver disease excluded (such as chronic viral hepatitis, autoimmune hepatitis, hemochromatosis,

Clinical, radiological, and pathologic associations

Twenty-five patients met the inclusion/exclusion criteria and consented to enroll in the study; 8 of these were categorized with steatosis and 17 with NASH. The 2 groups showed no differences in age, sex, body mass index, history of diabetes mellitus, or serum lipid levels. Patients with NASH had higher aspartate aminotransferase levels (P = 0.03), higher ferritin levels (P = 0.05), more hepatocyte ballooning (P < 0.0001), and more fibrosis (P = 0.002). Demographic, laboratory, and pathologic

Discussion

This is the largest and most in-depth study of patients with pathologically proven NAFLD in whom simultaneous radiological assessments with 3 different modalities were obtained shortly after liver biopsy. This study indicates that the severity of hepatic steatosis can be accurately determined radiologicalally only when there is moderate or severe (>33%) fatty infiltration of the liver documented by a liver biopsy. Although the role of US in assessing hepatic steatosis was reported in the 1980s,

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  • Cited by (0)

    Address requests for reprints to: Zobair M. Younossi, M.D., M.P.H., Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, Virginia 22042. e-mail: [email protected]; fax: (703) 698-3481.

    ☆☆

    Supported in part by a grant from the Cleveland Clinic Hepatology Research Institute (to Z.M.Y.).

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