Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases
Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases
复制标题
DOI：
10.1016/s1590-8658(02)80111-6
复制
发表时间：
2002-07-01
影响因子：
4.5
通讯作者：
Bodemar, G
中科院分区：
文献类型：
--
作者：
Mathiesen, UL;Franzén, LE;Bodemar, G
目标。目的：探讨肝脏高回声是否可以可靠地解释为肝脂肪变性，是否可以发现任何伴随或孤立的纤维化。患者和方法。165例因转氨酶（丙氨酸转氨酶和天冬氨酸转氨酶0.7-5.0 mukat/l）轻度至中度升高而无肝脏疾病体征或症状超过6个月的患者，通过综合实验室资料、肝脏超声检查和经皮肝活检进行前瞻性研究。根据美他韦对纤维化进行定量评估。脂肪变性分为无脂肪变性、轻度脂肪变性、中度脂肪变性和重度脂肪变性。98例（59.4%）回声增强患者中，B5例（86.7%）为肝脂肪变性至少模型化程度，相同程度的脂肪变性9例回声正常，无或仅轻度脂肪变性13例为高回声肝（敏感性0.90，特异性D. 82，阳性预测值0.87，阴性预测值0.87）。无论体重指数和纤维化程度如何，也发现了大致相同的关系。随着回声增强、高衰减（n=59）和门静脉壁区分降低（n=79），阳性预测值分别增加到0.93和0.94。定量评估的纤维化（平均+/- SD）正常时为活检面积的3.2+/-4.6%，回声增强时为2.3+/-1.8% （ns）。9例中隔纤维化患者中5例回声正常，6例肝硬化患者中4例回声正常。超声检查的任何结构性、非均匀性表现均与肝结构纤维化改变无关，也没有肝表面结节状轮廓。评估肝脏回声对发现或排除中度至明显的脂肪浸润（正确分类86.6%）有价值，但不能依赖于诊断纤维化，甚至不能用于轻度至中度转氨酶升高的无症状患者的肝硬化。
Aims. To Investigate whether hyperechogenicity of liver can reliably be interpreted as liver steatosis and if any concomitant or isolated fibrosis can be disclosed.Patients and methods. A series of 165 patients with no signs or symptoms of liver disease referred because of slightly to moderately raised aminotransferases (alanine aminotransferase andlor aspartate aminotransferase 0.7-5.0 mukat/l) for more than 6 months were prospectively investigated with a comprehensive laboratory profile, ultrasound examination of liver, and percutaneous liver biopsy. Fibrosis was assessed quantitatively and according to Metavir. Steatosis was graded as none, mild, moderate or severe.Results. Of 98 (59.4%) patients with raised echogenicity, B5 (86.7%) had liver steatosis of at least model-ate degree, 9 patients with same degree of steatosis had normal echogenicity and 13 patients with no or only mild steatosis had a hyperechogenic liver (sensitivity 0.90, specificity D. 82, positive predictive value 0.87, negative predictive value 0.87). About the same relations were found regardless of body mass index and degree of fibrosis. With increased echogenicity together with high attenuation (n=59) and reduced portal vessel wall distinction (n=79), positive predictive value increased to 0.93 and 0.94, respectively. Quantitatively assessed fibrosis (mean +/- SD) was 3.2+/-4.6% of biopsy area with normal and 2.3+/-1.8% with raised echogenicity (ns). Echogenicity was normal in 5 out of 9 patients with septal fibrosis and In 4 out of 6 patients with cirrhosis. Any structural, non-homogenous findings at ultrasound were not associated with architectural fibrotic changes and none had nodular contours of liver surface.Conclusions. Assessment of liver echogenicity is of value for detection or exclusion of moderate to pronounced fatty infiltration (correct classification 86.6%) but cannot be relied upon in diagnosing fibrosis, not even cirrhosis In asymptomatic patients with mild to moderately elevated liver transaminases.