Ultrasound diagnosis of fatty liver in patients with chronic liver disease - A retrospective observational study
Ultrasound diagnosis of fatty liver in patients with chronic liver disease - A retrospective observational study
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DOI：
10.1097/01.mcg.0000225680.45088.01
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发表时间：
2007-07-01
影响因子：
2.9
通讯作者：
Ehrinpreis, Murray N.
中科院分区：
文献类型：
--
作者：
Perez, Nolan E.;Siddiqui, Firdous A.;Ehrinpreis, Murray N.
目的：肝脏超声 (US) 很容易获得，医生通常相信美国报告显示脂肪肝的结果，但对其准确性的报告存在相互矛盾，特别是在慢性肝病 (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了比较。方法：对 131 名 CLD 患者（89% 患有慢性 Q 型肝炎）的肝活检进行了脂肪（0 至 3 级）、炎症（0 至 4 级）和纤维化（0 至 4 级）分级。肝脏超声解释分为 3 类：“正常”、“正常”和“正常”。根据回声强度，使用 3 种超声检查类别进行二次分析：正常、“回声增强”和“异质性”。然后将超声检查结果与肝活检结果进行比较。结果：正常的超声报告与许多假阴性相关，因为活检时 25% 的患者有脂肪（1 级至 3 级）；此外，46% 的患者有“明显的纤维化”。 （2 至 4 级）或“显着炎症”（2 至 4 级）。“脂肪肝”解释正确识别出活检中的脂肪为 36.4%，“显着脂肪”（2 至 3 级）为 11.4%，但回声增强的超声正确识别出脂肪为 43.5%，显着脂肪为 19.4%，但69.4% 的患者有明显的纤维化或明显的炎症，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%，具体取决于活检的脂肪变性程度和所考虑的超声检查解释。结论：超声诊断 CLD 患者的肝脏脂肪变性并不准确，回声异常更可能是由以下原因引起的。在这种情况下会出现纤维化或炎症。
Objectives: 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.Methods: 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 Q. 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.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.Conclusions: 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.