Skip to main content


Log in

Diagnostic Value of Ultrasonographic Examination for Nonalcoholic Steatohepatitis in Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery

  • Published:
Obesity Surgery Aims and scope Submit manuscript



There are few data relating to the role of fatty score (FS) and modified fatty score (MFS) in ultrasonographic (US) examination on the diagnosis of nonalcoholic steatohepatitis (NASH) in patients undergoing bariatric surgery.


We investigated consecutive patients undergoing laparoscopic bariatric surgery with biopsy-proven nonalcoholic fatty liver disease. Patients with other liver diseases and significant alcohol consumption were excluded. Clinico-demographic and anthropometric data were collected before surgery. Each biopsy specimen was assessed by the same pathologist. Liver US examinations were performed by an independent and experienced sonographer before surgery. FS and MFS, determined by the US scoring system based on degrees of parenchymal echogenicity, far gain attenuation, gallbladder wall blurring, portal vein wall blurring and hepatic vein blurring, were used to assess the severity of fatty liver. US findings were correlated with histologic results.


Totally 101 patients were enrolled. The mean BMI of the patients was 44.6 ±5.4 kg/m2. 29 patients (29%) were categorized with simple steatosis and 72 (71%) with NASH. FS and MFS were significantly correlated with the histological steatosis, fibrosis and the presence of NASH (P<0.001). A receiver operating characteristic curve identified the MFS of 2 as the best cut-off point for the prediction of NASH, yielding measures of sensitivity, specificity, positive predictive value, and accuracy for 72%, 86%, 93% and 76%, respectively. The positive likelihood ratio of 5.24 for MFS approximately doubled the post-test probability of NASH from 30% to 70%.


FS and MFS on US examination exhibit acceptable sensitivity and high specificity for the detection of the presence of NASH in morbidly obese patients and may aid in the selection of patients for closer follow-up or liver biopsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Marchesini G, Brizi M, Morselli-Labate AM et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999; 107: 450–5.

    Article  CAS  PubMed  Google Scholar 

  2. Mottin CC, Moretto M, Padoin AV et al. Histological behavior of hepatic steatosis in morbidly obese patients after weight loss induced by bariatric surgery. Obes Surg 2005; 15: 788–93.

    Article  PubMed  Google Scholar 

  3. Stratopoulos C, Papakonstantinou A, Terzis I et al. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg 2005; 15: 1154–60.

    Article  PubMed  Google Scholar 

  4. Matteoni C, Younossi Z, Gramlich T et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413–9.

    Article  CAS  PubMed  Google Scholar 

  5. Shalhub S, Parsee A, Gallagher SF et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg 2004; 14: 54–9.

    Article  PubMed  Google Scholar 

  6. Piccinino F, Sagnelli E, Pasquale G et al. Complications following percutaneous liver biopsy: a multicenter retrospective study on 68276 biopsies. J Hepatol 1986;2: 165–73.

    Article  CAS  PubMed  Google Scholar 

  7. Wolf AM, Busch B, Kuhlmann HW et al. Histological changes in the liver of morbidly obese patients: correlation with metabolic parameters. Obes Surg 2005; 15: 228–37.

    Article  PubMed  Google Scholar 

  8. Ong JP, Elaring H, Collantes R et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg 2005;15: 310–5.

    Article  PubMed  Google Scholar 

  9. Boza C, Riquelme A, Ibanez L et al. Predictors of nonalcoholic steatohepatitis (NASH) in obese patients undergoing gastric bypass. Obes Surg 2005; 15: 1148–53.

    Article  PubMed  Google Scholar 

  10. Harnois F, Msika S, Sabate JM et al. Prevalence and predictive factors of nonalcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery. Obes Surg 2006; 16: 183–8.

    Article  PubMed  Google Scholar 

  11. Yang PM, Huang GT, Lin JT et al. Ultrasonography in the diagnosis of benign diffuse parenchymal liver disease: a prospective study. J Formos Med Assoc 1988; 87: 966–77.

    CAS  Google Scholar 

  12. Siegelman ES, Rosen MA. Imaging of hepatic steatosis. Semin Liver Dis 2001; 21: 71–80.

    Article  CAS  PubMed  Google Scholar 

  13. Mottin CC, Moretto M, Pandoin AV et al. The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients. Obes Surg 2004; 14: 635–7.

    Article  PubMed  Google Scholar 

  14. Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg 2004; 14: 1165–70.

    Article  PubMed  Google Scholar 

  15. Lewis MC, Phillips ML, Slavotinek JP et al. Changes in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg 2006; 16: 697–701.

    Article  PubMed  Google Scholar 

  16. Saadeh S, Younossi ZM, Remer E et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002;123:745–50.

    Article  PubMed  Google Scholar 

  17. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: 1221–31.

    Article  CAS  PubMed  Google Scholar 

  18. Matthews DR, Hosker JP, Rudenski AS et al. Homeostasis model assessment: insulin resistance and β-cell function from plasma fasting glucose and insulin concentrations in man. Diabetologia 1985;28:412–9.

    Article  CAS  PubMed  Google Scholar 

  19. Banner BF, Savas L, Zivny J et al. Ubiguitin as a marker of cell injury in nonalcoholic steatohepatitis. Am J Clin Pathol 2000; 114: 860–6.

    Article  CAS  PubMed  Google Scholar 

  20. Brunt EM, Janney CJ, Di Bisceglie AM et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histologic lesions. Am J Gastroenterol 1999; 94: 2467–74.

    Article  CAS  PubMed  Google Scholar 

  21. Promrat K, Lutchman G, Uwaifo GI et al. A pilot study of pioglitazone treatment for nonalcoholic steatohepatitis. Hepatology 2004; 39: 188–96.

    Article  CAS  PubMed  Google Scholar 

  22. Marchesini G, Bugianesi E, Forlani G et al. Nonalcoholic fatty liver steatohepatitis and the metabolic syndrome. Hepatology 2003; 37: 917–23.

    Article  PubMed  Google Scholar 

  23. Munoz SR, Bangdiwala SI. Interpretation of kappa and B statistic measures of agreement. J Appl Stat 1997; 24: 105–11.

    Article  Google Scholar 

  24. Quinn SF, Gosink BB. Characteristic sonographic signs of hepatic fatty infiltration. Am J Roentgenol 1985; 145: 753–5.

    CAS  Google Scholar 

  25. Di Lelia A, Cestari C, Lomazzi A et al. Cirrhosis: diagnosis with ultrasonographic study of the liver surface. Radiology 1989; 172: 389–92.

    Google Scholar 

  26. Sackett DL, Haynes BR, Guyatt GH et al. The interpretation of diagnostic data. In: Clinical Epidemiology: a Basic Science for Clinical Medicine. 2nd Edn. Boston, MA: Little, Brown, 1991: 69–152.

    Google Scholar 

  27. Andersen T, Gluud C. Liver morphology in morbid obesity: a literature study. Int J Obes 1984; 8: 97–106.

    CAS  PubMed  Google Scholar 

  28. Abrams GA, Kunde SS, Lazenby AJ et al. Portal fibrosis and hepatic steatosis in morbidly obese subjects: a spectrum of nonalcoholic fatty liver disease. Hepatology 2004; 40: 475–83.

    Article  PubMed  Google Scholar 

  29. Suchman AL, Dolan JG. Odds and likelihood ratios. In: Black ER, Bordley DR, Tape TG et al, eds. Diagnostic Strategies for Common Medical Problems. 2nd Edn. Philadelphia, PA: American College of Physicians 1999: 31–6.

    Google Scholar 

  30. Layer G, Zuna I, Lorenz A et al. Computerized ultrasound B-scan texture analysis of experimental diffuse parenchymal liver disease: correlation with histopathology and tissue composition. J Clin Ultrasound 1991; 19: 193–201.

    Article  CAS  PubMed  Google Scholar 

  31. Kim SH, Lee JM, Kim JH et al. Appropriateness of a donor liver with respect to macrosteatosis: application of artificial neural networks to US images - initial experience. Radiology 2005; 234: 793–803.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ming-Shiang Wu MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liang, RJ., Wang, HH., Lee, WJ. et al. Diagnostic Value of Ultrasonographic Examination for Nonalcoholic Steatohepatitis in Morbidly Obese Patients Undergoing Laparoscopic Bariatric Surgery. OBES SURG 17, 45–56 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words