title: The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis.
abstract: OBJECTIVE
  The observation of bright liver echo pattern on ultrasound is commonly considered a sign of hepatic steatosis. However, the interference of liver fibrosis on sensitivity and specificity of bright liver echo pattern has caused many to question its effectiveness as a diagnostic tool. The objective of this study was to evaluate the sensitivity, specificity and predictive values of bright liver echo pattern for liver steatosis.
  
  
  METHODS
  We studied 235 consecutive patients suspected of having liver disease of various aetiologies. Median age was 52 years (range, 17-72 years), and there was a male/female ratio of 1:18. All patients underwent ultrasound examination before liver biopsy and was performed by two operators. The presence or absence of bright liver echo pattern and posterior attenuation or areas with different patterns of fat infiltration were noted. Histologic evaluation was performed and graded by Ishak score. Steatosis was categorised as absent, 0-2%, 3-29% to 30-49% or >50%.
  
  
  RESULTS
  Interobserver concordance was high. Bright liver echo pattern was found in 67% of patients with steatosis of any degree and 89% of patients with steatosis of >or=30%. Only three patients without steatosis, who had a low Ishak score, demonstrated bright liver echo pattern on ultrasonography. The sensitivity, specificity, positive predictive value and negative predictive value of bright liver echo pattern for steatosis were 64%, 97%, 96.0% and 65%, respectively. Among the subgroup of patients who had steatosis of >or=30%, the sensitivity, specificity, positive predictive value and negative predictive value of bright liver echo pattern were 91%, 93%, 89% and 94%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of posterior attenuation and/or skip areas associated with bright liver echo pattern for steatosis were 89.7%, 100%, 100% and 92.3%, respectively. Univariate analysis showed bright liver echo pattern to be associated only with steatosis and not with fibrosis.
  
  
  CONCLUSIONS
  We concluded that the presence of bright liver echo pattern is a sign of liver steatosis and that liver fibrosis does not interfere with ultrasound measurements. Posterior attenuation and/or skip areas are closely related to steatosis of >or=30%.
authors.affiliation: Department of Internal Medicine, Hepatology, and Gastroenterology, Second University of Naples, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Palmentieri
authors.forename: I
authors.initials: I
authors.lastname: de Sio
authors.forename: V
authors.initials: V
authors.lastname: La Mura
authors.forename: M
authors.initials: M
authors.lastname: Masarone
authors.forename: R
authors.initials: R
authors.lastname: Vecchione
authors.forename: S
authors.initials: S
authors.lastname: Bruno
authors.forename: R
authors.initials: R
authors.lastname: Torella
authors.forename: M
authors.initials: M
authors.lastname: Persico
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005234:Fatty Liver / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014463:Ultrasonography