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The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis

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Abstract

Purpose

To evaluate the prevalence of bright liver echo pattern (BLP) on ultrasonography and its correlation with liver steatosis (LS), and fibrosis in patients with chronic hepatitis C. The usefulness of detecting skip areas for steatosis diagnosis has also been evaluated.

Methods

The study included 88 patients with chronic hepatitis C (55 men, 33 women, average age 45.7 ± 11.2 years). Ultrasound examination was performed in all patients before liver biopsy. The presence of BLP was assessed and graded from 1 to 3. Hypoechogenic areas (skip areas) around the gallbladder or near the portal vein were also evaluated. Hepatic fibrosis was assessed using the Ishak fibrosis score. Steatosis was graded as follows: 1, 2, 3 (<30, 30–70, >70 % of hepatocytes affected, respectively).

Results

Fifty-three of the 88 patients (60 %) showed BLP (40 grade 1, 13 grades 2 or 3). Skip areas were found in 14 patients (16 %). Histological steatosis was observed in 40 patients (45 %) and in 10 of them (25 %) was grades 2 and 3 (4 and 6 patients, respectively). As regards fibrosis, 2 patients showed F0, 34 F1, 28 F2, 20 F3, 4 F4, none of them F5 and F6. BLP of grades 2 or 3 and presence of skip areas were strongly correlated with LS (P = 0.00007 and P = 0.00003, respectively). No correlation was found between BLP and fibrosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of BLP for LS were 75, 50, 56, 68 and 61 %, respectively. When BLP of grades 2 and 3 and LS of 30 % or more were correlated, the sensitivity, specificity, PPV, NPV and accuracy of BLP were 72, 96, 61, 96 and 90 %, respectively. As regards skip areas the sensitivity, specificity, PPV, NPV and accuracy for LS were 35, 100, 100, 64 and 70 %, respectively.

Conclusions

In a well-defined group of patients with chronic hepatitis C, the detection of BLP grades 2 and 3 has a good sensitivity and high specificity for high grades of steatosis. A high specificity but low sensitivity for liver steatosis was also found for skip areas, whereas mild fibrosis does not seem to correlate with the hyperechogenicity of the liver.

Riassunto

Scopo

Scopo del lavoro é stato quello di valutare la prevalenza del “bright liver echo pattern” (BLP) all’ultrasonografia e la sua correlazione con la steatosi epatica (SE) e la fibrosi in un gruppo di pazienti con epatite cronica C. E’ stata valutata anche l’utilità della determinazione delle cosiddette “aree di risparmio” per la diagnosi di steatosi.

Metodi

Lo studio ha incluso 88 pazienti con epatite cronica C (55 di sesso maschile, 33 di sesso femminile; età media 45.7 ± 11.2 anni). L’esame ultrasonografico é stato eseguito in tutti i pazienti prima di effettuare la biopsia epatica. La presenza di BLP é stata graduata da 1 a 3. É stata anche valutata la presenza o meno di aree ipoecogene (cosiddette “aree di risparmio”), adiacenti alla colecisti o in sede parailare epatica. La fibrosi epatica é stata stadiata istologicamente utilizzando la classificazione di Ishak. La steatosi epatica é stata graduata da un punto di vista istologico come segue: 1, 2, 3 (a seconda che il grado di interessamento degli epatociti era rispettivamente <30, da 30 a 70, >70 %).

Risultati

Cinquantatre degli 88 pazienti (60 %) hanno mostrato BLP (40 di grado 1, 13 di grado 2 o 3). In 14 pazienti (16 %) sono state rilevate “aree di risparmio”. Istologicamente la steatosi é stata evidenziata in 40 % dei pazienti (45 %) e in 10 di loro (25 %) era di grado 2 e 3 (4 e 6 pazienti rispettivamente). Per quanto riguarda la fibrosi, 2 pazienti hanno presentato F0, 34 F1, 28 F2, 20 F3, 4 F4, nessuno F5 e F6. BLP di grado 2 o 3 e la presenza di “aree di risparmio” era strettamente correlata con SE (P = 0.00007 a P = 0.0003, rispettivamente). Nessuna correlazione é stata trovata tra BLP e fibrosi. La sensibilità, specificità, valore predittivo positivo (VPP), valore predittivo negativo (VPN) e accuratezza della BLP per SE sono stati rispettivamente 75, 50, 56, 68 e 61 %. Quando sono state messe in correlazione BLP di grado 2 e 3 e SE di 30 % o più, sensibilità, specificità, VPP, VPN e accuratezza della BLP sono stati rispettivamente 72, 96, 61, 96 e 90 %. Per quanto riguarda le “aree di risparmio” sensibilità, specificità, VPP, VPN e accuratezza per SE sono stati rispettivamente 35, 100, 100, 64 e 70 %.

Conclusioni

In un ben definito gruppo di pazienti con epatite cronica C, la determinazione di BLP di grado 2 e 3 ha mostrato una buona sensibilità ed un’alta specificità per la steatosi epatica di grado elevato. Un’alta specificità per SE, associata a bassa sensibilità, é stata anche riscontrata per le cosiddette “aree di risparmio”, mentre la fibrosi moderata non sembra correlare con l’ipercogenicità del fegato.

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Conflict of interest

Maurizio Loy, Giancarlo Serra, Luchino Chessa declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

Human and animal studies

The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.

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Authors and Affiliations

  1. Ultrasonography Unit, CDR, Via Zagabria 60, 09129, Cagliari, Italy

    Maurizio Loy

  2. Liver Unit, Department of Medical Sciences, Policlinico Universitario, University of Cagliari, SS 554 Bivio Sestu, 09042, Monserrato, Cagliari, Italy

    Giancarlo Serra & Luchino Chessa

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  1. Maurizio Loy
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  2. Giancarlo Serra
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  3. Luchino Chessa
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Correspondence to Maurizio Loy.

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Loy, M., Serra, G. & Chessa, L. The prevalence of bright liver echo pattern in patients with chronic hepatitis C: correlation with steatosis and fibrosis. J Ultrasound 19, 91–98 (2016). https://doi.org/10.1007/s40477-014-0114-5

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  • DOI: https://doi.org/10.1007/s40477-014-0114-5

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