Perez Nolan E, Siddiqui Firdous A, Mutchnick Milton G, Dhar Ravi, Tobi Martin, Ullah Nadeem, Saksouk Faysal A, Wheeler Don E, Ehrinpreis Murray N
Division of Gastroenterology, Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
J Clin Gastroenterol. 2007 Jul;41(6):624-9. doi: 10.1097/01.mcg.0000225680.45088.01.
Hepatic ultrasound (US) is readily available and physicians usually trust the results of an US report suggesting fatty liver, but there are conflicting reports on its accuracy, especially in patients with chronic liver disease (CLD). Therefore, we retrospectively examined liver biopsies in patients with CLD and compared the histologic results to the hepatic US findings.
Liver biopsies were graded for fat (grades 0 to 3), inflammation (grades 0 to 4), and fibrosis (stages 0 to 4) in 131 patients with CLD (89% had chronic hepatitis C). Hepatic US interpretations were grouped into 3 categories-"normal," "fatty liver," and "nonspecific." A secondary analysis was performed using 3 sonographic categories based on the echogenicity: normal, "increased echogenicity," and "heterogenous." The US results were then compared with the liver biopsy results.
A normal US report was associated with many false negatives, as 25% of these patients had fat (grades 1 to 3) on biopsy; furthermore, 46% had "significant fibrosis" (stages 2 to 4) or "significant inflammation" (grades 2 to 4). A "fatty liver" interpretation correctly identified fat on biopsy in 36.4% and "significant fat" (grades 2 to 3) in 11.4%, but 66% had significant fibrosis or significant inflammation. An US with increased echogenicity correctly identified fat in 43.5% and significant fat in 19.4%, but 69.4% had significant fibrosis or significant inflammation. The sensitivity of an US ranged from 11.4% to 88.2% and the specificity ranged from 40.4% to 86.2%, depending on the degree of steatosis on biopsy and the sonographic interpretation being considered.
US is inaccurate for diagnosing hepatic steatosis in patients with CLD. Echogenic abnormalities are more likely to be the result of fibrosis or inflammation in this setting.
肝脏超声检查（US）易于进行，医生通常信赖提示脂肪肝的超声检查报告结果，但关于其准确性存在相互矛盾的报道，尤其是在慢性肝病（CLD）患者中。因此，我们回顾性检查了CLD患者的肝活检，并将组织学结果与肝脏超声检查结果进行比较。
对131例CLD患者（89%患有丙型肝炎）的肝活检进行脂肪分级（0至3级）、炎症分级（0至4级）和纤维化分期（0至4期）。肝脏超声检查结果分为3类——“正常”、“脂肪肝”和“非特异性”。基于回声性进行了二次分析，分为3个超声类别：正常、“回声增强”和“不均匀”。然后将超声检查结果与肝活检结果进行比较。
正常的超声检查报告存在许多假阴性，因为这些患者中有25%在活检时存在脂肪（1至3级）；此外，46%有“显著纤维化”（2至4期）或“显著炎症”（2至4级）。“脂肪肝”的诊断在活检时正确识别出脂肪的比例为36.4%，识别出“显著脂肪”（2至3级）的比例为11.4%，但66%有显著纤维化或显著炎症。回声增强的超声检查正确识别出脂肪的比例为43.5%，识别出显著脂肪的比例为19.4%，但69.4%有显著纤维化或显著炎症。超声检查的敏感性范围为11.4%至88.2%，特异性范围为40.4%至86.2%，这取决于活检时脂肪变性的程度以及所考虑的超声诊断。
超声检查在诊断CLD患者的肝脂肪变性方面不准确。在这种情况下，回声异常更可能是纤维化或炎症的结果。
