Assessment of Hepatic Steatosis by Expert Pathologists

El‐Badry, Ashraf Mohammad; Breitenstein, Stefan; Jochum, Wolfram; Washington, Kay; Paradis, Valérie; Rubbia‐Brandt, Laura; Puhan, Milo A.; Slankamenac, Ksenija; Graf, Rolf; Clavien, Pierre Alain

doi:10.1097/sla.0b013e3181bcd6dd

Cited by 271 publications

(292 citation statements)

References 28 publications

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“…Although substantial, this level of agreement is not perfect, which may explain the misclassifications. Future validation studies between MR imaging and biopsy may involve the use of histomorphometry for software-based quantitative assessment of liver fat vacuoles (50), as these automated image analysis methods have been shown to correlate with macrovesicular fat assessment by a pathologist (51), while being less affected by the interreader variability in the assessment of microvesicular and macrovesicular steatosis by pathologists (28).…”

Section: Discussionmentioning

confidence: 99%

“…Liver biopsy is the current clinical reference standard for diagnosis of hepatic steatosis and grading its severity (24). However, biopsy is invasive, semiquantitative, observer dependent, and prone to sampling variability (25)(26)(27)(28)(29)(30)(31). These limitations make biopsy a suboptimal first-line test for assessment of hepatic steatosis (32).…”

Section: Implication For Patient Carementioning

confidence: 99%

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Accuracy of MR Imaging–estimated Proton Density Fat Fraction for Classification of Dichotomized Histologic Steatosis Grades in Nonalcoholic Fatty Liver Disease

Tang¹,

Desai²,

Hamilton³

et al. 2015

Radiology

251

216

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Hospital Queens, Queens, NY.q RSNA, 2014 Purpose:To evaluate the diagnostic performance of previously proposed high-specificity magnetic resonance (MR) imaging-estimated proton density fat fraction (PDFF) thresholds for diagnosis of steatosis grade 1 or higher (PDFF threshold of 6.4%), grade 2 or higher (PDFF threshold of 17.4%), and grade 3 (PDFF threshold of 22.1%) by using histologic findings as a reference in an independent cohort of adults known to have or suspected of having nonalcoholic fatty liver disease (NAFLD). Materials andMethods:This prospective, cross-sectional, institutional review boardapproved, HIPAA-compliant single-center study was conducted in an independent cohort of 89 adults known to have or suspected of having NAFLD who underwent contemporaneous liver biopsy. MR imaging PDFF was estimated at 3 T by using magnitude-based low-flip-angle multiecho gradientrecalled-echo imaging with T2* correction and multipeak modeling. Steatosis was graded histologically (grades 0, 1, 2, and 3, according to the Nonalcoholic Steatohepatitis Clinical Research Network scoring system). Sensitivity, specificity, and binomial confidence intervals were calculated for the proposed MR imaging PDFF thresholds. Results:The proposed MR imaging PDFF threshold of 6.4% to diagnose grade 1 or higher steatosis had 86% sensitivity (71 of 83 patients; 95% confidence interval [CI]: 76, 92) and 83% specificity (five of six patients; 95% CI: 36, 100). The threshold of 17.4% to diagnose grade 2 or higher steatosis had 64% sensitivity (28 of 44 patients; 95% CI: 48, 78) and 96% specificity (43 of 45 patients; 95% CI: 85, 100). The threshold of 22.1% to diagnose grade 3 steatosis had 71% sensitivity (10 of 14 patients; 95% CI: 42, 92) and 92% specificity (69 of 75 patients; 95% CI: 83, 97). Conclusion:In an independent cohort of adults known to have or suspected of having NAFLD, the previously proposed MR imaging PDFF thresholds provided moderate to high sensitivity and high specificity for diagnosis of grade 1 or higher, grade 2 or higher, and grade 3 steatosis. Prospective multicenter studies are now needed to further validate these high-specificity thresholds.q RSNA, 2014

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Section: Discussionmentioning

confidence: 99%

Section: Implication For Patient Carementioning

confidence: 99%

Accuracy of MR Imaging–estimated Proton Density Fat Fraction for Classification of Dichotomized Histologic Steatosis Grades in Nonalcoholic Fatty Liver Disease

Tang¹,

Desai²,

Hamilton³

et al. 2015

Radiology

251

216

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“…Computerized programs have been developed to more objectively quantitate hepatic steatosis by determining the area occupied by lipid droplets in a given field of a liver section (El-Badry et al, 2009). However, these quantitative methods provide information only on the total amount of fat, omitting any data on the chemical composition of hepatic lipids.…”

Section: Omega-3 Pufasmentioning

confidence: 99%

“…How much fat, and what types of fat, represent a significant risks for primary non-function of the graft remain under debate. The assessment of donor liver fat is a difficult task for the transplant team due to large inconsistencies in the qualitative and quantitative measurement of fat deposits in the liver (El-Badry et al, 2009;McCormack et al, 2011).…”

Section: Adipocytokines Derived From Liver And/or Adipose Tissuementioning

confidence: 99%

Ischemia-Reperfusion Injury Associated with Liver Transplantation in 2011: Past and Future

Elias-Miró¹,

Jiménez‐Castro²,

Peralta³

2012

Liver Transplantation - Basic Issues

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“…Early methods aim to correlate pathologist assessment for the steatosis staging with quantitative results of digital image analysis. Such an approach [15][16][17] either uses morphometric analysis, without providing imaging details, or employs software packages such as Image Pro Plus [18] for simple thresholding application. Classical image processing techniques, such as morphology operations and algorithms, have been also used.…”

Section: Related Workmentioning

confidence: 99%

Automated Detection of Liver Histopathological Findings Based on Biopsy Image Processing

et al. 2017

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Hepatic steatosis is the accumulation of fat in the hepatic cells and the liver. Triglycerides and other kinds of molecules are included in the lipids. When there is some defect in the process, hepatic steatosis arise, during which the free fatty acids are taken by the liver and exuded as lipoproteins. Alcohol is the main cause of steatosis when excessive amounts are consumed for a long period of time. In many cases, steatosis can lead to inflammation that is mentioned as steatohepatitis or non-alcoholic steatohepatitis (NASH), which can later lead to fibrosis and finally cirrhosis. For automated detection and quantification of hepatic steatosis, a novel two-stage methodology is developed in this study. Initially, the image is processed in order to become more suitable for the detection of fat regions and steatosis quantification. In the second stage, initial candidate image regions are detected, and then they are either validated or discarded based on a series of criteria. The methodology is based on liver biopsy image analysis, and has been tested using 40 liver biopsy images obtained from patients who suffer from hepatitis C. The obtained results indicate that the proposed methodology can accurately assess liver steatosis.

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Assessment of Hepatic Steatosis by Expert Pathologists

Cited by 271 publications

References 28 publications

Accuracy of MR Imaging–estimated Proton Density Fat Fraction for Classification of Dichotomized Histologic Steatosis Grades in Nonalcoholic Fatty Liver Disease

Accuracy of MR Imaging–estimated Proton Density Fat Fraction for Classification of Dichotomized Histologic Steatosis Grades in Nonalcoholic Fatty Liver Disease

Ischemia-Reperfusion Injury Associated with Liver Transplantation in 2011: Past and Future

Automated Detection of Liver Histopathological Findings Based on Biopsy Image Processing

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