Clinical–Liver, Pancreas, and Biliary TractThe utility of radiological imaging in nonalcoholic fatty liver disease☆,☆☆
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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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.
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Supported in part by a grant from the Cleveland Clinic Hepatology Research Institute (to Z.M.Y.).