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Statistical agreement between ultrasound (US) and computerized tomography (CT) for non-alcoholic liver disease (NAFLD) diagnosis

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Journal of the International AIDS Society200811 (Suppl 1) :P139

https://doi.org/10.1186/1758-2652-11-S1-P139

  • Published:

Keywords

  • Computerize Tomography
  • Gallbladder Wall
  • Ultrasound Beam
  • Alcohol User
  • Imaging Agreement

Purpose of the Study

To assess K statistic of non-invasive imaging evaluations to diagnose NAFLD by means of US fatty liver indicator (FLI) score and liver to spleen attenuation ratio by CT.

Methods

Cross-sectional observational study that included all consecutive HIV-infected patients seen at a metabolic clinic who were screened for NAFLD with US and CT in the same day. HCV, HBV and heavy alcohol users (>20 g/day) were excluded. With CT, NAFLD diagnosis was defined with an L/S<1.1. US scanning was performed by a single operator. Presence and severity of steatosis was evaluated by a semiquantitative echographic score (FLI) graduated from 2 to 8. "Sine qua non" condition for the diagnosis of steatosis was the presence of liver/kidney contrast, graduated as mild/moderate (score 2) and severe (score 3). Additional criteria (score 1 each) included posterior attenuation of ultrasound beam, vessel blurring, difficult visualization of gallbladder wall or diaphragm and areas of focal sparing. US NAFLD was diagnosed by the score ≥2.

Summary of Results

46 patients were included. NAFLD prevalence with US was 19.57% and with CT 50.00%. (Tables 1 and 2).

K of Cohen coefficent between L/S ≤1.1 and US score ≥2 was 0.21 (agreement = 60.87%), US score ≥3 was 0.45 (agreement = 80.43%), US score ≥4 was 0.29 (agreement = 80.43%).

Table 1

 

Total

NAFLD+ CT

NAFLD+ US

P-value

Male

34 (73.91)

9 (100)

16 (69.57)

.002*

Age, (range)

47.91 (25; 68)

49.55 (37; 57)

48.39 (33; 67)

.71§

CCD C, n (%)

9 (19.57)

3 (33.33)

5 (21.74)

.45*

Duration of HIV infection

178.26 (52; 278)

172.11 (52; 255)

185.68 (52; 278)

.60§

CD4 cell count

554 (153; 1197)

590 (290; 760)

539 (180; 1197)

1†

Log10 VL

2.10 (1.60; 4.72)

2.22 (1.60; 4.50)

2.23 (1.60; 4.72)

.98§

NRTI cumulative exp, months (range)

187.97 (8; 614)

182.55 (22; 317)

196.87 (22; 614)

.78§

NNRTI cumulative exp, months (range)

47.18 (1; 131)

35 (12; 82)

32.81 (1; 111)

.85§

PI cumulative exp, months (range)

68.73 (1; 593)

59.44 (21; 120)

81.82 (1; 593)

.59§

AST/ALT

1.00 (0.51; 2.1)

.86 (0.51; 1.45)

.94 (0.51; 1.54)

.55§

Waist

86.54 (69; 113)

90.11 (78; 113)

89.58 (77; 113)

.90§

*2-sample test of proportion; § 2-sample unpaired t-test; † Wilcoxon signed-rank test.

Table 2

 

US+ CT+

US- CT-

US+ CT-

US- CT+

Agreement

Kappa

C.I. 95%

All Patients n = 70

11

33

22

4

62.86%

.23

.03; .43

HCV- n = 46

7

21

16

2

60.87%

.22

-.01; .45

Conclusion

Non-invasive imaging agreement between US and CT to diagnose NAFLD is less than ideal. Best concordance is found for US ≥3 and L/S ≤1.1. Liver biopsy studies are needed to validate cut-off of US evaluation and L/S in people living with HIV.

Authors’ Affiliations

(1)
University of Modena and Reggio Emilia, Modena, Italy

Copyright

© Zona et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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