The purpose of our paper was to evaluate the performance of ultrasound (US) for assessment of the severity of liver steatosis as compared to a pathological examination, which is presently considered to be the gold standard, in patients that have undergone liver biopsy for various reasons. We performed echo-assisted liver biopsy in 161 patients with chronic hepatitis with the US aspect of “bright liver” with “posterior attenuation”, using modified Menghini needles. Following the US examination, the severity of liver steatosis was estimated as minimal, mild, moderate. or severe according to the Hepburn classification: absent (affecting 0% to 2% of the hepatocytes), minimal (2% to 10%), mild (10% to 30%), moderate (30% to 60%), and severe (more than 60% of the hepatocytes). The results of this study showed that the sensitivity of US for the prediction of histological steatosis of at least moderate severity was 0.64, with 0.77 specificity, 0.55 positive predictive value, and 0.94 negative predictive value. The overall accuracy was 0.75. This study showed that the transabdominal ultrasound evaluation of the fatty liver is a quite good predictor, perhaps sufficient for most purposes, for the estimation of the severity of liver steatosis in the moderate to severe range.
