Diffuse hepatic steatosis (grading)

Dr Bruno Di Muzio and Dr Ayush Goel et al.

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

Grading

  • grade I: diffusely increased hepatic echogenicity but periportal and diaphragmatic echogenicity is still appreciable
  • grade II: diffusely increased hepatic echogenicity obscuring periportal echogenicity but diaphragmatic echogenicity is still appreciable 
  • grade III: diffusely increased hepatic echogenicity obscuring periportal as well as diaphragmatic echogenicity 

Practical points

It is important not to fall into the pitfall that all diffusely echogenic livers are fatty, other pathologies may produce identical appearances, including cirrhosis.

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.

Article information

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

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Cases and figures

  • Case 1: grade I
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  • Case 2: grade I
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  • Case 3: grade II
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  • Case 4: grade III
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  • Case 5: grade III
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