title: Digital quantification is more precise than traditional semiquantitation of hepatic steatosis: correlation with fibrosis in 220 treatment-naïve patients with chronic hepatitis C.
abstract: BACKGROUND
  Steatosis, as associated with chronic hepatitis C (CHC) and non-alcoholic fatty liver disease (NAFLD), has been considered a risk factor for development of fibrosis.
  
  
  OBJECTIVE
  Our aims were to determine if correlations existed between the degree of steatosis and fibrosis in treatment-naïve CHC patients, and to compare the accuracy of digital image analysis with semiquantification (manual assessment) to quantify hepatic steatosis.
  
  
  METHODS
  We studied 220 treatment-naïve, liver biopsy-proven CHC patients, including a serial biopsy sub-cohort of 37 patients with a mean interval of 3.82 years. Steatosis and fibrosis % were evaluated using digital quantification of steatosis (DQS) and fibrosis contrasted with manual assessment.
  
  
  RESULTS
  Most patients had <6% steatosis measured manually and digitally. Overall, manual assessment of steatosis was 3.78 times greater than DQS. Increasing steatosis % was associated with advancing fibrosis stage, both manually and digitally. Intraobserver reliability for DQS showed higher intraclass correlation reproducibility (r = 0.98, P < 0.001) than the manual method (r = 0.81, P < 0.01). Interobserver concordance for DQS had an average measure intraclass correlation of r = 0.99. Cirrhotics were more likely than non-cirrhotics to have grade 2 steatosis.
  
  
  CONCLUSIONS
  Increased steatosis was associated with increased fibrosis. DQS was consistently more precise and reproducible than manual assessment of steatosis in grades 1 (1 to <6%) and 2 (6 to <34%), and may prove to be especially preferable in clinical trials of pharmacotherapeutic agents.
authors.affiliation: Department of Medicine, Division of Gastroenterology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA.
authors.forename: Sekou R
authors.initials: SR
authors.lastname: Rawlins
authors.forename: Ola
authors.initials: O
authors.lastname: El-Zammar
authors.forename: J Michael
authors.initials: JM
authors.lastname: Zinkievich
authors.forename: Nancy
authors.initials: N
authors.lastname: Newman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
mesh_terms: D000368:Aged; D000886:Anthropometry; D001707:Biopsy, Needle; D015331:Cohort Studies; D016001:Confidence Intervals; D003952:Diagnostic Imaging / Q000379:methods*; D005234:Fatty Liver / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
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