Palmentieri B, de Sio I, La Mura V, Masarone M, Vecchione R, Bruno S, Torella R, Persico M
Department of Internal Medicine, Hepatology, and Gastroenterology, Second University of Naples, Italy.
Dig Liver Dis. 2006 Jul;38(7):485-9. doi: 10.1016/j.dld.2006.03.021. Epub 2006 May 22.
The observation of bright liver echo pattern on ultrasound is commonly considered a sign of hepatic steatosis. However, the interference of liver fibrosis on sensitivity and specificity of bright liver echo pattern has caused many to question its effectiveness as a diagnostic tool. The objective of this study was to evaluate the sensitivity, specificity and predictive values of bright liver echo pattern for liver steatosis.
We studied 235 consecutive patients suspected of having liver disease of various aetiologies. Median age was 52 years (range, 17-72 years), and there was a male/female ratio of 1:18. All patients underwent ultrasound examination before liver biopsy and was performed by two operators. The presence or absence of bright liver echo pattern and posterior attenuation or areas with different patterns of fat infiltration were noted. Histologic evaluation was performed and graded by Ishak score. Steatosis was categorised as absent, 0-2%, 3-29% to 30-49% or >50%.
Interobserver concordance was high. Bright liver echo pattern was found in 67% of patients with steatosis of any degree and 89% of patients with steatosis of >or=30%. Only three patients without steatosis, who had a low Ishak score, demonstrated bright liver echo pattern on ultrasonography. The sensitivity, specificity, positive predictive value and negative predictive value of bright liver echo pattern for steatosis were 64%, 97%, 96.0% and 65%, respectively. Among the subgroup of patients who had steatosis of >or=30%, the sensitivity, specificity, positive predictive value and negative predictive value of bright liver echo pattern were 91%, 93%, 89% and 94%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of posterior attenuation and/or skip areas associated with bright liver echo pattern for steatosis were 89.7%, 100%, 100% and 92.3%, respectively. Univariate analysis showed bright liver echo pattern to be associated only with steatosis and not with fibrosis.
We concluded that the presence of bright liver echo pattern is a sign of liver steatosis and that liver fibrosis does not interfere with ultrasound measurements. Posterior attenuation and/or skip areas are closely related to steatosis of >or=30%.
超声检查中肝脏回声增强模式通常被视为肝脂肪变性的标志。然而，肝纤维化对肝脏回声增强模式的敏感性和特异性的干扰使得许多人质疑其作为诊断工具的有效性。本研究的目的是评估肝脏回声增强模式对肝脂肪变性的敏感性、特异性和预测价值。
我们研究了235例连续怀疑患有各种病因肝病的患者。中位年龄为52岁（范围17 - 72岁），男女比例为1:18。所有患者在肝活检前均接受了超声检查，由两名操作人员进行。记录有无肝脏回声增强模式、后方衰减或不同脂肪浸润模式的区域。进行组织学评估并根据Ishak评分进行分级。脂肪变性分为无、0 - 2%、3 - 29%、30 - 49%或>50%。
观察者间一致性较高。在任何程度脂肪变性的患者中，67%发现有肝脏回声增强模式，在脂肪变性≥30%的患者中，89%发现有该模式。只有3例无脂肪变性且Ishak评分较低的患者在超声检查中表现出肝脏回声增强模式。肝脏回声增强模式对脂肪变性的敏感性、特异性、阳性预测值和阴性预测值分别为64%、97%、96.0%和65%。在脂肪变性≥30%的患者亚组中，肝脏回声增强模式的敏感性、特异性、阳性预测值和阴性预测值分别为91%、93%、89%和94%。与肝脏回声增强模式相关的后方衰减和/或跳跃区域对脂肪变性的敏感性、特异性、阳性预测值和阴性预测值分别为89.7%、100%、100%和92.3%。单因素分析显示肝脏回声增强模式仅与脂肪变性相关，而与纤维化无关。
我们得出结论，肝脏回声增强模式的存在是肝脂肪变性的标志，且肝纤维化不干扰超声测量。后方衰减和/或跳跃区域与≥30%的脂肪变性密切相关。
