title: Non-invasive assessment of liver steatosis in non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  The diagnosis of non-alcoholic fatty liver disease (NAFLD) is based on the histological findings. Further, there may be interobserver differences. Liver to spleen (L/S) ratio on computed tomography (CT) is employed to detect or even quantify the fat content of the liver. The objective of this study was to accurately diagnose fatty liver by evaluating the relationship between L/S ratio and histological findings.
  
  
  METHODS
  Sixty-seven biopsy-proven NAFLD patients were enrolled. L/S ratio on CT was calculated. The area of steatosis in liver specimens was measured by BIOREVO BZ-9000 microscope, and the percentage of steatosis was calculated using Dynamic cell count BZ-H1C software.
  
  
  RESULTS
  Steatotic grade assessed by pathologist was significantly correlated with the percentage of steatosis and L/S ratio. Factors associated with steatosis were L/S ratio, aspartate aminotransferase and Homeostasis Model of Assessment - Insulin Resistance as determined by multivariate analysis. L/S ratios were: S0, 1.16 ± 0.20 (mean ± standard deviation); S1, 0.88 ± 0.28; S2, 0.76 ± 0.20; and S3, 0.40 ± 0.18, respectively. The optimal cut-off value of L/S ratio to exclude steatosis was 1.1, and the area under the receiver-operator curve for the diagnosis of steatosis was 0.886.
  
  
  CONCLUSIONS
  Our study suggests that while 0% of steatosis showed 1.296 L/S ratio, the cut-off value of L/S ratio would be 1.1 at least to exclude clinically important liver steatosis.
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kan
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kimura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hyogo
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fukuhara
authors.forename: Hatsue
authors.initials: H
authors.lastname: Fujino
authors.forename: Noriaki
authors.initials: N
authors.lastname: Naeshiro
authors.forename: Yohji
authors.initials: Y
authors.lastname: Honda
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kawaoka
authors.forename: Masataka
authors.initials: M
authors.lastname: Tsuge
authors.forename: Akira
authors.initials: A
authors.lastname: Hiramatsu
authors.forename: Michio
authors.initials: M
authors.lastname: Imamura
authors.forename: Yoshiiku
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ochi
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
keywords: liver to spleen ratio; non-alcoholic fatty liver disease; non-invasive assessment; steatotic grade