Digestive Diseases and Sciences

, Volume 55, Issue 7, pp 2049–2057

Digital Quantification Is More Precise than Traditional Semiquantitation of Hepatic Steatosis: Correlation with Fibrosis in 220 Treatment-Naïve Patients with Chronic Hepatitis C

  • Sekou R. Rawlins
  • Ola El-Zammar
  • J. Michael Zinkievich
  • Nancy Newman
  • Robert A. Levine
Original Article



Steatosis, as associated with chronic hepatitis C (CHC) and non-alcoholic fatty liver disease (NAFLD), has been considered a risk factor for development of fibrosis.


Our aims were to determine if correlations existed between the degree of steatosis and fibrosis in treatment-naïve CHC patients, and to compare the accuracy of digital image analysis with semiquantification (manual assessment) to quantify hepatic steatosis.


We studied 220 treatment-naïve, liver biopsy-proven CHC patients, including a serial biopsy sub-cohort of 37 patients with a mean interval of 3.82 years. Steatosis and fibrosis % were evaluated using digital quantification of steatosis (DQS) and fibrosis contrasted with manual assessment.


Most patients had <6% steatosis measured manually and digitally. Overall, manual assessment of steatosis was 3.78 times greater than DQS. Increasing steatosis % was associated with advancing fibrosis stage, both manually and digitally. Intraobserver reliability for DQS showed higher intraclass correlation reproducibility (r = 0.98, P < 0.001) than the manual method (r = 0.81, P < 0.01). Interobserver concordance for DQS had an average measure intraclass correlation of r = 0.99. Cirrhotics were more likely than non-cirrhotics to have grade 2 steatosis.


Increased steatosis was associated with increased fibrosis. DQS was consistently more precise and reproducible than manual assessment of steatosis in grades 1 (1 to <6%) and 2 (6 to <34%), and may prove to be especially preferable in clinical trials of pharmacotherapeutic agents.


Cirrhosis Image analysis Liver biopsy Intraclass correlation Steatosis 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sekou R. Rawlins
    • 1
  • Ola El-Zammar
    • 2
  • J. Michael Zinkievich
    • 1
  • Nancy Newman
    • 1
  • Robert A. Levine
    • 1
    • 3
  1. 1.Department of Medicine, Division of GastroenterologyState University of New York, Upstate Medical UniversitySyracuseUSA
  2. 2.Department of PathologyState University of New York, Upstate Medical UniversitySyracuseUSA
  3. 3.Department of Medicine, Section of GastroenterologyBoston Medical CenterBostonUSA

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