Diffuse hepatic steatosis (grading)
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At the time the article was created Ayush Goel had no recorded disclosures.
View Ayush Goel's current disclosuresAt the time the article was last revised Karen Machang'a had no financial relationships to ineligible companies to disclose.
View Karen Machang'a's current disclosures- Grading of fatty liver
Grading of diffuse hepatic steatosis on ultrasound has been used to communicate to the clinician about the extent of fatty changes in the liver.
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Grading using ultrasound B-mode
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
Grading using controlled attenuation parameter (CAP)
Steatosis is correlated with signal attenuation during liver stiffness assessment using the controlled attenuation parameter (CAP). The CAP provides extra information on ultrasonic signal attenuation during Transient Elastography examination5. This provides a standardized non-invasive measure of hepatic steatosis. The results are given in decibels per meter (dB/m).
Controlled attenuation parameter (CAP) technology for assessing steatosis:
s0: normal (below 184 dB/m)
s1: mild (184-248 dB/m)
s2: moderate (249-280 dB/m)
-
s3: severe (above 280 dB/m)
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.
CAP values are influenced by a number of variables including NAFLD, diabetes, BMI, older age, presence of ascites5.
References
- 1. Singh D, Das CJ, Baruah MP. Imaging of non alcoholic fatty liver disease: A road less travelled. Indian J Endocrinol Metab. 2013;17 (6): 990-5. doi:10.4103/2230-8210.122606 - Free text at pubmed - Pubmed citation
- 2. Perez NE, Siddiqui FA, Mutchnick MG et-al. Ultrasound diagnosis of fatty liver in patients with chronic liver disease: a retrospective observational study. J. Clin. Gastroenterol. 2007;41 (6): 624-9. doi:10.1097/01.mcg.0000225680.45088.01 - Pubmed citation
- 3. Strauss S, Gavish E, Gottlieb P et-al. Interobserver and intraobserver variability in the sonographic assessment of fatty liver. AJR Am J Roentgenol. 2007;189 (6): W320-3. doi:10.2214/AJR.07.2123 - Pubmed citation
- 4. Brunt EM, Janney CG, Di Bisceglie AM et-al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am. J. Gastroenterol. 1999;94 (9): 2467-74. doi:10.1111/j.1572-0241.1999.01377.x - Pubmed citation
- 5. Ferraioli G & Soares Monteiro L. Ultrasound-Based Techniques for the Diagnosis of Liver Steatosis. World J Gastroenterol. 2019;25(40):6053-62. doi:10.3748/wjg.v25.i40.6053 - Pubmed
- 6. Sirli R & Sporea I. Controlled Attenuation Parameter for Quantification of Steatosis: Which Cut-Offs to Use? Can J Gastroenterol Hepatol. 2021;2021:6662760. doi:10.1155/2021/6662760 - Pubmed
- 7. Karlas T. Estimating Steatosis and Fibrosis: Comparison of Acoustic Structure Quantification with Established Techniques. WJG. 2015;21(16):4894. doi:10.3748/wjg.v21.i16.4894 - Pubmed
Incoming Links
- Diffuse hepatic steatosis with renal cortical cyst
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- Diffuse fatty liver - response to therapy and weight loss
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