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Ultrasonographic Diagnosis of Fatty Liver in Preoperative Evaluation of Living Liver Donor Candidates:Histologic Correlation |
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Seong Hyun Kim, M.D. Won Jae Lee, M.D. Hyo Keun Lim, M.D. Sooah Kim, M.D. Seung Hoon Kim, M.D. Soon Jin Lee, M.D. Jae Hoon Lim, M.D. |
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Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine |
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PURPOSE : To analyze the correlation between the ultrasonographic (US) grading system of fatty liver (FL) and histologic
grading system in living liver donor candidates and to investigate the clinical significance of this qualitative
US grading system in the selection of living donor candidates.
MATERIALS and METHODS : For a recent 21-month period, ninety three living donor candidates who underwent both
preoperative US and parenchymal biopsy of the liver were consecutively selected. FL was ultrasonographically
graded using the well-known three-point grading system (ie, mild, moderate and severe degrees) whereas histologic
grade of FL was divided into minimal (<10%), mild (11-30%), moderate (31-60%) and severe (>60%)
degrees depending upon the percentages of each of macrovesicular, microvesicular and total fat-containing hepatocytes.
US grade and histologic grade of FL in each patient were retrospectively correlated according to the
US and pathologic records in their databases. Statistical analysis was conducted with the chi-square test and linear
by linear association.
RESULTS : US findings included the normal liver, mild FL, and moderate FL in 63, 23 and 7 patients, respectively.
Analyzed with the total fat content, 38 of 63 patients (60%) whose USfinding was normal proved to have FL of
various histologic grades. Meanwhile, US grade of FL correlated well with the histologic grade in 16 (53%) of
30 patients who showed mild or moderate FL on US, and in the remaining patients, US grade was more commonly
underestimated compared to the histologic grade. All patients with moderate FL on US proved to have
either moderate or severe FL at histology. US grade statistically correlated well with the histologic grade classified
by either the total or macrovesicular fat contents (p<.001) while a poor correlation was seen when histologic
grade using the microvesicular fat content was used.
CONCLUSION : The well-known qualitative US grading system of fatty liver seems to show a relatively good correlation
with the histologic grade, but it has a tendency to underestimate compared to the histologic grade, particularly
when histologic grade using the total fat content was used. Therefore, it seems unnecessary to undergo preoperative
liver biopsy when the US grade is greater than moderate FL in living donor candidate. However, the
normal US finding might require liver biopsy. |
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Keyword : Liver, transplantation Liver, fatty Liver, US |
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pdf파일 : 11-18 김성현.pdf
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