Diffuse hepatic steatosis (grading)

Grading of diffuse hepatic steatosis on ultrasound has been used to communicate to the clinician about the extent of fatty changes in the liver. 


  • grade I: increased hepatic echogenicity with visible periportal and diaphragmatic echogenicity
  • grade II: increased hepatic echogenicity with imperceptible periportal echogenicity, without obscuration of diaphragm
  • grade III: increased hepatic echogenicity with imperceptible periportal echogenicity and obscuration of diaphragm

Practical points

Some suggest that visual grading of hepatic steatosis is subject to a wide interobserver and intraobserver variability 3

There is also a histological three point scale for grading severity of non-alcoholic steatohepatitis 4. These two grading systems are not currently correlated.

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Article Information

rID: 33279
Synonyms or Alternate Spellings:
  • Grading of fatty liver

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Cases and Figures

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    Case 1: grade I
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    Case 2: grade II
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