title: Liver hemodynamic patterns in nonalcoholic steatosis: Doppler ultrasonography and histological evaluation.
abstract: BACKGROUND
  The aim of this study was to evaluate hepatic Doppler ultrasound (US) indices for steatosis diagnosis and grading, having biopsy as reference.
  
  
  METHODS
  Doppler and conventional US were performed in 49 healthy volunteers, without risk factors for nonalcoholic fatty liver disease (NAFLD), and in 49 patients with NAFLD and at least one risk factor: obesity, dyslipidemia and/or diabetes mellitus. Significant alcohol intake and hepatitis B or C were exclusion criteria. NAFLD patients were biopsied, and steatosis severity graded histologically. Portal Venous Pulsatility Index (PVI), Hepatic Artery Resistance Index (HARI) and Pulsatility Index (HAPI) were analyzed in hilum. Hepatic vein waveform pattern (HVWP) was classified as triphasic, biphasic or monophasic. Two pathologists analyzed histological samples. ROC curve defined sensitivity and specificity and multivariate analysis defined an equation for classifying patients.
  
  
  RESULTS
  In NAFLD group, 89.79% had histologic criteria for non-alcoholic steatohepatitis (NASH). Mild steatosis was present in 44.89%, moderate steatosis in 38.77% and severe steatosis in 16.32%. In NAFLD group, 65.29% were obese and body mass index (BMI) had significant correlation with steatosis grading (r=0.77; P<0.0001). PVI correlated with presence of steatosis (r=-0.69, P<0.0001) as HVWP (r=-0.61, P< 0.0001). PVI ideal cutoff for predicting steatosis was 0.26 (sensitivity, 91%; specificity, 79.6%). The equation 16.15PVI+1.96HVWP enables to differentiate the healthy and the steatosis patients. HARI and HAPI could not differentiate the healthy from the steatosis group. None of the indices correlated with steatosis grading.
  
  
  CONCLUSIONS
  Portal and hepatic vein indices allow non-invasive steatosis diagnosis but are limited to quantify it. Histology remains important for steatohepatitis diagnosis and for steatosis grading.
authors.affiliation: Pathology Department, Federal University of Uberlândia, Uberlândia Minas Gerais, Brazil - marialuizapatologia@gmail.com.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Gonçalves Dos Reis Monteiro
authors.forename: Valéria
authors.initials: V
authors.lastname: Ferreira De Almeida E Borges
authors.forename: Tânia
authors.initials: T
authors.lastname: Machado De Alcântara
authors.forename: Lúcio
authors.initials: L
authors.lastname: Borges De Araújo
authors.forename: Conceição
authors.initials: C
authors.lastname: De Fátima Pinheiro
authors.forename: Angélica
authors.initials: A
authors.lastname: Lemos Debs Diniz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D009765:Obesity / Q000150:complications; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods