Histogram of ultrasound in diagnosing and grading of fatty liver
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Objective To explore the value of the histogram of ultrasound in diagnosing and grading of fatty liver.Methods Ninety subjects were enrolled in normal group,light or moderate to severe fatty liver group(each n =30),respectively.All the subjects underwent histogram of ultrasound of the liver,kidney,spleen and right hepatic vein(RHV),and the ratio of histogram M value of different area were analyzed.Results Statistical differences of the ratio of histogram M value of anterior hepatic tissue of kidney and kidney(AntK)between normal group and two fatty liver groups were detected(P 0.05).The ratio of histogram M value of anterior hepatic tissue of RHV and RHV(AntV)between the normal group and moderate to severe fatty liver group,as well as the light and moderate to severe fatty liver group had statistical differences(P 0.05).When 0.97,0.78 were used respectively as the critical value of the ratio of histogram M value in diagnosing and grading of fatty liver at AntK and AntV,the sensitivity was all 80.00% and 80.00%,specificity was 85.00% and 70.00%,respectively.Conclusion The ratio of histogram M value of AntK,AntV can be used as the referent index in diagnosing and grading of fatty liver.Keywords:
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Objective: To investigate the quantitative analysis of tissue diffusion by ultrasonic elastography in the grading of fatty liver.Methods: Thirty-six patients' liver tissue samples were graded according to their level of steatosis.Before liver biopsy,the gray scale ultrasonography was performed in all patients,then,ultrasonic elastography was performed on liver tissue of ROI.The percentage of blue color in the ROI was calculated by the quantitative analysis of tissue diffusion.The elastogram was compared with level of liver steatosis.Results: Steatosis level of the thirty-six patients' liver tissue: less than 30%(normal group) in 12 patients,30%~50%(mild fatty liver group) in 9 patients,50%~75%(moderate fatty liver group) in 8 patients and more than 75%(severe fatty liver group) in 7 patients.There were different characteristics in the groups' elastogram.The difference of percentage of the blue color in ROI was statistically significant among groups.The correlation coefficient of percentage of the blue color in the ROI area and pathological stage of liver steatosis was r=0.832(P=0.000).Percentage of blue area increased with the degree of fatty liver.Conclusion: The quantitative analysis of tissue diffusion is helpful for the diagnosis in the fatty liver degree,and plays an important role in clinic.
Steatosis
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Liver tissue
Liver steatosis
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Biochemical, histological and CT examinations of the liver were performed in 32 rabbits on significance of measuring CT values in the diagnosis of fatty liver. In 2 groups of rabbits, in which 2g/kg/day and 4g/kg/day of fat emulsion were administered intravenously for 4 weeks respectively, post-treatment reduction in CT value of light degree was observed. In a group, in which 8g/kg/day were given, there was a sufficient reduction in CT value for giving diagnosis of fatty liver of moderate degree. Significant correlation was found between changes in CT value of the liver on the one hand and contents of triglyceride, total cholesterol and cholesterol ester in the liver on the other hand, while there was, no significant correlation between changes in CT value and contents of phospholipid, protein and water. Significant correlation was found between changes in CT value of the liver and degrees of histological fat accumulation in the liver cells. It has been evidenced experimentally that prolonged administration of fat emulsion may cause fatty liver, and that measurement of CT values of the liver is a non-aggressive method of diagnosing fatty liver.
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Fat emulsion
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The reversibility of alcoholic fatty liver is well-known. The present study aims to investigate whether sonographic controls can document this reversibility under abstinence therapy with respect to inter-observer variability.59 male patients with alcohol dependency were examined by ultrasound at the beginning and the end of a long-term in-patient withdrawal therapy. Fatty liver was graded qualitatively (no, slight, moderate and severe fatty liver). The sonographic liver sections were registered digitally per examination and were subsequently evaluated by means of the PC by two independent experts. Additionally, a digital texture analysis of representative hepatic and renal regions was performed. The pixel intensity ratio of liver and kidney was used as a measure of liver echogenicity.In the ultrasound examination, the 59 patients had the following severity grade of fatty liver initially: 18 (31 %) severe, 19 (32 %) moderate, 22 (37 %) slight. 37 patients (63 %) showed sonographically an improvement of the initial severity grade within 79 +/- 26 days (p < 0.0001, 95 % confidence interval: 50 - 74 %). The evaluation by the independent experts revealed 47 and 54 % improvement, respectively. The overall degree of agreement between the 3 ratings concerning grading and course was high (intraclass coefficient = 0.896). However, there was a marked deviation between the several grading levels (agreement 15 - 86 %). The categorical differentiation between no/slight versus moderate/severe fatty liver revealed an agreement of between 81 and 91 %. The mean pixel intensity ratio showed an improvement of 17 % (p < 0.0001).After 3 months abstinence an improvement of alcoholic fatty liver can be consistently documented in about 50 % of the cases by sonography. The interobserver variability on differentiating no/slight versus moderate/severe fatty liver was low. The digital texture analysis confirmed the range of reversibility and could play a role in quantifying the sonographic degree of fatty infiltration.
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Objective To discuss the change of liver perfusion parameters by MSCT in pig models of fatty liver. Materials and Methods Pig models of fatty liver (n=10,experimental group) and normal liver (n=3,control group) were selected, the perfusion imaging and liver biopsy were performed and liver perfusion parameters were calculated in 0, 4, 8 weekend. Results 10 pigs of the experimental group had fatty hepatitis in 4 weekend, and hepatic fibrosis in 8 weekend,but the control group were normal. The HAP, PVP, THBF decreased gradually, which were (28.00±11.42,19.30±9.12,17.52±16.29)ml·min-1·100 ml-1,(79.58±21.78,41.87±28.41,22.84±13.44)ml·min-1·100 ml-1,(107.58±25.70,61.17±31.87,40.37±17.19)ml·min-1·100 ml-1, respectively; but the HPI increased,(26.76±9.01,38.24±21.85,43.52±24.42)%. There was statistical difference between the subgroups (P0.05). The HAP, PVP, THBF and HPI of the control group had no statistical difference in 0, 4, 8 weekend (P0.05), which were(31.30±15.01,27.19±11.60,21.33±8.57)ml·min-1·100 ml-1,(91.68±25.67,69.02±21.21,81.90±14.60)ml·min-1·100 ml-1,(122.98±33.97,96.21±24.00,108.23±13.48)ml·min-1·100 ml-1,and(26.21±9.01,28.91±9.56,24.88±8.21)%, respectively. There were difference of the liver perfusion parameters between experimental group and control group except 0 weekend. Conclusion MSCT can measure the perfusion parameters of fatty liver, the changes of parameters were found in the fatty liver compared to the normal stage.
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Background: This study was aimed to evaluate the discrepancy between hepatic fat fraction based on MR chemical shifting images (MRC) and hepatic fatty change of the frozen section as well as the regional difference of hepatic fat and its clinical importance using MRC. Patients and Methods: Between Feb. 2010 and Jun. 2012, 278 living donor liver transplantations were performed at Seoul National University Hospital. 29 living liver donors who had fatty liver (macro-vesicular fatty change > 5%) were retrospectively reviewed. Fat fraction was estimated in the different 13 regions of the liver (segment 1, 2, 3 and the peripheral & deep portion of segment 4, 5, 6, 7, 8) on MRC images. And the pathologic report for frozen section of their liver biopsy was investigated. Results: The degree of discrepancy between liver frozen biopsy and fat fraction from MRC was increased corresponding to the level of fatty change on biopsy. And the degree of regional difference in the hepatic fat also depends on the amount of fat content. The difference of fat fraction went up to 10.6% in this study. And the highest fatty region of 25 donors (86.71%) was located in the right liver right liver and the lowest fatty region of 17 donors (58.62%) was in left liver. Conclusion: Because a needle or wedge biopsy cannot represent the remaining liver completely, especially in a fatty liver, MRC will be helpful to realize the accurate amount of hepatic fat and its regional distribution.
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Abstract Purpose This study was conducted to evaluate the effect of various degrees of diffuse fatty infiltration of the liver on the hepatic artery resistance index. Methods One‐hundred forty subjects were examined using standard color and spectral Doppler sonography protocols. Fatty infiltration of the liver was identified and graded sonographically. The patients were grouped (n = 35 in each of 4 groups) according to the degree of diffuse fatty infiltration of the liver as follows: normal (group 1), mild (group 2), moderate (group 3), and severe (group 4). The resistance index calculated for each patient was the mean of 3 measurements. Mean resistance index of the hepatic artery was then calculated for each group. Results The mean resistance index was 0.81 ± 0.04 for group 1, 0.79 ± 0.06 for group 2, 0.75 ± 0.05 for group 3, and 0.73 ± 0.05 for group 4. We found a statistically significant ( p < 0.05) decrease in resistance index when comparing groups 3 and 4 with groups 1 and 2 separately. Conclusions Hepatic artery resistance index decreases as the severity of diffuse fatty infiltration increases. © 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:95–99, 2005
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Objective To establish the CT criteria of quantitative diagnosis for liver steatosis by means of studying the CT features of fatty liver cases proven histologically. Methods Twenty-eight cases of fatty liver were underwent non-enhanced CT scan, and the attenuation of liver parenchyma was measured. To differentiate the degree of fatty liver, the mean CT value and the relative density of hepatic vessels were observed. The quantitative diagnosis was made according to the CT number threshold and the criteria of relative density of hepatic vessels, respectively. Results Among the 28 cases, there were 17 cases of mild steatosis with mean CT number of 46 HU (32-65 HU), 7 cases of middle degree fatty liver with mean CT number of 28 HU (15-38 HU), and 4 cases of sever fatty liver with mean CT number of 0.2 HU (-7-11 HU). For the relative density of hepatic vessels, 16 of the 17 cases of mild fatty liver had a appearance of hepatic vessels immersion and 1 mild case had reverse hepatic vessels display, 6 of 7 middle degree cases had reverse hepatic vessels display with 1 case having the appearance of hepatic vessels immersion, and all the 4 case of sever steatosis had the appearance of reverse hepatic vessels display with sharp contrast between vessels and the liver parenchyma. The accuracy of quantitative diagnosis was 65.9% and 93.1% by means of criteria of CT number threshold and relative density of hepatic vessels, respectively (χ 2=7.153,P0.01). Conclusion The criteria of relative density of hepatic vessels is more reliable than that of CT number threshold in quantitative diagnosis of fatty liver.
Steatosis
Liver parenchyma
Parenchyma
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Purpose: Our goal was to determine whether spleen or muscle can be used as a qualitative standard of reference for diagnosing fatty infiltration of liver on contrast-enhanced CT. Method: Qualitative visual comparisons and quantitative region-of-interest measurements of liver, spleen, and muscle were made on scans of 96 patients who underwent dynamic CT before and after injection of intravenous contrast material. As the standard of reference, the portion of liver assessed was considered fatty if its attenuation measured less than spleen on noncontrast CT. Results: In 16 (17%) scans, the portion of liver assessed was fatty on noncontrast CT. After contrast material administration, the attenuation of that portion of liver measured less than splenic attenuation in 93 (97%) of 96 cases (including all 16 fatty livers). Only four (25%) fatty livers, and no nonfatty livers, were visually judged to be less attenuating than muscle after contrast material; these four were the most fatty shown on noncontrast CT. Comparing hepatic and splenic attenuation on postcontrast CT resulted in a specificity of 30% and a positive predictive value of 20%; comparing hepatic and muscle attenuation on postcontrast CT yielded corresponding values of 100 and 100% but a sensitivity of 25%. Conclusion: For the visual assessment of fatty liver, spleen is not an accurate reference standard on contrast-enhanced CT. However, fatty liver can be diagnosed on contrast-enhanced CT if liver appears less attenuating than muscle-a situation that occurs only if fatty infiltration is pronounced.
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Objective To study the non-invasive,quantitative ultrasonic diagnostic criteria of fatty liver by establishing the rat model fed with high fat diet,using ultrasonic histogram(Hist-B).Methods The fatty liver rat model was developed.Forty healthy male Wistar rats were randomly divided into two groups:control group(n=15)was fed with normal diet,and model group(n=25) was fed with high-fat diet.The rat' s liver was monitord by ultrasonography and histopathology at weeks 4,6,8,10,and 12,to the detect average value of gray-scale by Hist-B of Toshiba 350A computed sonographer.Histopathological staining method was HE.Quantitative ultrasonic diagnostic criteria were calculated.Results According to the pathological findings in the liver,the average value of gray-scale was 7.99±0.65 in normal group,15.20±0.74 in mild degree fatty degeneration group,24.38±2.17 in medium degree fatty degeneration group,and 35.44±2.58 in severe degree fatty degenera- tion group.Ultrasonography histogram assay was superior to macroscopic observation.The former had a sensitivity of 88%,a specificity of 93%,and an accuracy of 90%,while the latter had 76%,87%,and 80%,respectively.Conclusions Rat fatty liver models can be developed in a short time by high fat diet.Ultrasonic histogram can reflect the fatty liver disease and judge the fat degree in liver.So it may serve as a reliable non-invasive tool for the quantitative diagnosis of fatty liver disease and judge its severity.
Histopathology
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