Sonography Predicts Liver Steatosis in Patients With Chronic Hepatitis B.
OBJECTIVE
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.
Division of Gastroenterology and Hepatology, University of Ottawa, Ottawa, Ontario, Canada.
Erin M
EM
Kelly
Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
Vickie A
VA
Feldstein
The Ottawa Hospital, Ottawa, Ontario, Canada.
Dustin
D
Etheridge
Division of Pharmacy, University of California, San Francisco, California, USA.
Rebecca
R
Hudock
Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA.
Marion G
MG
Peters
D005234:Fatty Liver / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods*
fatty liver; gastrointestinal ultrasound; hepatitis B virus; liver biopsy; sonography