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Hypoechoic lesions in fatty liver. Quantitative study by histomorphometry.

E Caturelli1, L Costarelli, M Giordano

  • 1Divisione di Gastroenterologia, Ospedale Generale Regionale Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.

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Ultrasonography reveals focal liver lesions in fatty liver disease. Hypoechoic lesions have fewer fat droplets, while hyperechoic lesions have more, explaining ultrasonic contrast.

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Area of Science:

  • Hepatology
  • Medical Imaging
  • Pathology

Background:

  • Fatty liver disease is characterized by fat accumulation in hepatocytes.
  • Ultrasonography is commonly used to assess liver parenchyma echogenicity.
  • Focal liver lesions in fatty liver disease can present as hypoechoic or hyperechoic areas.

Purpose of the Study:

  • To investigate the underlying microstructural differences in focal liver lesions observed via ultrasonography in patients with fatty liver changes.
  • To correlate ultrasonographic findings (hypoechogenicity and hyperechogenicity) with morphometric analysis of fat content and droplet size.

Main Methods:

  • Liver biopsies were performed on ten patients with fatty liver changes.
  • Ultrasonography was used to identify focal hypoechoic and hyperechoic lesions.
  • Morphometric analysis quantified fat area density and lipid droplet numerical density in lesional and perilesional tissues.

Main Results:

  • Six of seven hypoechoic lesions showed significantly lower numerical density of lipid droplets compared to surrounding parenchyma.
  • Three hyperechoic lesions exhibited significantly higher numerical density of lipid droplets.
  • Area density of fat was not significantly different between lesional and perilesional areas in most cases.

Conclusions:

  • Hypoechoic focal lesions in fatty liver disease likely represent areas with fewer, larger lipid droplets.
  • Hyperechogenicity may result from a higher number of smaller fat vacuoles.
  • Variations in the number of lipid droplet interfaces explain the ultrasonic contrast observed.