Sonography Predicts Liver Steatosis in Patients With Chronic Hepatitis B

Erin M Kelly; Vickie A Feldstein; Dustin Etheridge; Rebecca Hudock; Marion G Peters

doi:10.7863/ultra.16.04076

Sonography Predicts Liver Steatosis in Patients With Chronic Hepatitis B

J Ultrasound Med. 2017 May;36(5):925-932. doi: 10.7863/ultra.16.04076. Epub 2017 Feb 2.

Authors

Erin M Kelly¹, Vickie A Feldstein², Dustin Etheridge³, Rebecca Hudock⁴, Marion G Peters⁵

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
³ The Ottawa Hospital, Ottawa, Ontario, Canada.
⁴ Division of Pharmacy, University of California, San Francisco, California, USA.
⁵ Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.

PMID: 28151547
DOI: 10.7863/ultra.16.04076

Abstract

Objectives: Liver inflammation and fibrosis may impair the ability of sonography to identify steatosis. We determined the accuracy of sonography in grading steatosis in patients with chronic hepatitis B compared to liver biopsy.

Methods: We conducted was a single-center retrospective study of all nontransplanted patients with chronic hepatitis B undergoing sonography and liver biopsy between 2004 and 2014 (n = 109). Steatosis was graded by sonography as none, mild, moderate, or severe. Liver histologic analysis graded steatosis (0, <5%; 1, <33%; 2, <66%; or 3, ≥66%) and staged fibrosis (F0-F4). Severe steatosis was defined as grade 2 or 3. Clinical variables within 6 months of liver biopsy were collected, and the association with steatosis was analyzed by univariate logistic regression.

Results: Patients were predominantly Asian (83%), male (62%), and hepatitis B e antigen negative (62%). Twenty-nine percent of patients were obese; 9% had diabetes mellitus; 23% had hypertension; and 31% had dyslipidemia. Forty-four percent of patients had steatosis on liver biopsy; 8% had severe steatosis. The presence of any steatosis on sonography correctly identified any steatosis on liver biopsy in 29 of 48 patients (60%). The absence of steatosis on sonography ruled out severe steatosis on biopsy (specificity, 100%). Severe steatosis on sonography correctly predicted the presence of severe steatosis on liver biopsy (89%; P < .001); however, it was not accurate at distinguishing between steatosis grades. Predictors of biopsy-proven steatosis on univariate analysis included diabetes (P < .001), hypertension (P = .03), hypercholesterolemia (P = .02), and body mass index (P < .001).

Conclusions: Sonography had excellent accuracy in identifying patients with steatosis on biopsy. Abdominal sonography can be used to predict clinically important steatosis in patients with chronic hepatitis B.

Keywords: fatty liver; gastrointestinal ultrasound; hepatitis B virus; liver biopsy; sonography.

MeSH terms

Fatty Liver / complications*
Fatty Liver / diagnostic imaging*
Female
Hepatitis B, Chronic / complications*
Humans
Liver / diagnostic imaging
Male
Middle Aged
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Ultrasonography / methods*