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Reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related
M Soresi1, L Giannitrapani, A M Florena
1Department of Clinical Medicine and Emerging Pathologies, University of Palermo, Palermo, Italy.
Insights
The bright liver echo pattern on ultrasound reliably detects steatosis in chronic cryptogenic hypertransaminasaemia (CCH). This ultrasound finding is more accurate for CCH than for hepatitis C virus (HCV)-related hypertransaminasaemia.
Area of Science:
- Hepatology
- Medical Imaging
- Diagnostic Ultrasound
Background:
- Elevated liver enzymes (hypertransaminasaemia) can stem from various causes, including chronic cryptogenic hypertransaminasaemia (CCH) and hepatitis C virus (HCV) infection.
- Fatty liver disease (steatosis) is a common finding in patients with hypertransaminasaemia and can be assessed through liver biopsy or imaging techniques.
Purpose of the Study:
- To assess the diagnostic accuracy of the bright liver (BL) ultrasound sign for detecting histological steatosis.
- To compare the reliability of the BL sign in patients with CCH versus those with HCV-related hypertransaminasaemia.
Main Methods:
- A study involving 150 patients (54 with CCH, 96 with HCV) with hypertransaminasaemia.
- Histological steatosis was quantified as the percentage of hepatocytes involved.
- Ultrasound's bright liver sign reliability was evaluated using sensitivity, specificity, and predictive values.
Main Results:
- Histological steatosis was prevalent in 68% of patients, with higher rates in the CCH group (79.6%) than the HCV group (62%).
- The bright liver sign showed higher sensitivity in CCH (88%) compared to HCV genotype 1/2 (61%), indicating better diagnostic performance.
- Steatosis percentage was significantly associated with the bright liver pattern and was higher in CCH patients.
Conclusions:
- The bright liver echo pattern demonstrates excellent reliability for diagnosing steatosis in CCH.
- The diagnostic accuracy of the bright liver sign is superior in CCH compared to HCV-related hypertransaminasaemia due to higher steatosis prevalence and extent.
Aim:
To evaluate the reliability of the bright liver (BL) echo pattern on ultrasound to detect histological steatosis in chronic cryptogenic hypertransaminasaemia (CCH) and hepatitis C virus (HCV)-related forms of hypertransaminasaemia.
Materials And Methods:
One hundred and fifty patients, 54 with CCH and 96 with HCV hypertransaminasaemia (76 genotype 1/2 and 20 genotype 3), were enrolled. Histological steatosis was measured as the percentage of hepatocytes involved. The reliability of the BL sign was estimated using the sensitivity, specificity, positive and negative predictive values.
Results:
Histological steatosis was present in 102/150 patients (68%) divided into 59/96 (62%) in the HCV group and 43/54 (79.6%) in the CCH group (chi(2)=4.4; p=0.035). In a multivariate analysis, the variable associated with the BL echo pattern was steatosis percentage (p=0.0018). Steatosis percentage was higher in CCH group than in the HCV genotype 1/2 and 3 groups (p=0.02). The sensitivity of the BL echo pattern was 88% in the CCH group [confidence interval (CI) 95% 74-95] versus 61% (CI 95% 44-73) in the HCV genotype 1/2 group. The CI indicates that ultrasound can provide evidence for steatosis in a statistically significant way in the CCH versus HCV genotype 1/2 patients. In the genotype 3 group, the sensitivity was high (90%), but the limited number of cases limited the statistical significance due to the high CI.
Conclusion:
In CCH the BL echo pattern has excellent reliability in diagnosing steatosis, better than in HCV hypertransaminasaemia because of the higher prevalence and extent of steatosis.
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