Abstract
OBJECTIVE. The hepatorenal index has
been reported to be a sensitive and noninvasive test to quantify steatosis, but
it is cumbersome and time-consuming and requires specialized software. The aim
of this study was to improve and simplify the hepatorenal index calculation and
determine whether it is an effective tool for differentiating patients with
steatosis from those without steatosis, thereby eliminating the need for biopsy
in a large number of patients.
MATERIALS
AND METHODS. One hundred
one patients who had undergone ultrasound-guided percutaneous liver biopsy at
our institution were selected from a patient database. Patients with renal
disease, patients with liver masses, and patients whose liver and right kidney
were not included on the same image were excluded. Images were acquired with
high-resolution ultrasound, and the hepatorenal index was calculated using
freeware based on comparison of hepatic and renal brightness.
RESULTS. Of the 101 patients, 63 had
5% or less steatosis and 38 had more than 5% steatosis. Using freeware
available online from the National Institutes of Health, we calculated
hepatorenal index values for all patients. Our data showed a strong correlation
between the hepatorenal index and percentage of fat (r = 0.71, p < 0.0001). A hepatorenal
index of 1.28 or greater had a 100% sensitivity for identifying more than 5%
fat, 54% specificity, 0.57 positive predictive value, and 1.0 negative
predictive value. If this method had been used prospectively to select patients
for biopsy in our sample, 34% of biopsies could have been avoided.
CONCLUSION. The hepatorenal index is a
simple, reliable, and cost-effective screening tool for identifying patients
who should not undergo liver biopsy for evaluation of steatosis.
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