This was a prospective clinical study, carried out between September 1990 and October 1995 at the department of Gastroenterology, Çukurova University Medical School, Adana. The male /female ratio was 30/22 . Ultrasonographic evaluation was performed using Toshiba SAL- 38 ultrasonography by a gastroenterologist specializing in gastroenterologic. Following ultrasonographic evaluation, a complete physical examination, past medical history and informed consent was taken from the patients in this study. Fasting blood glucose level, prothrombin time, markers of viral hepatitis, SMA 12, serum lipid profile, lipoprotein electrophoresis and whole blood count (WBC) were evaluated in addition to the liver biopsy. Patients with positive hepatitis markers were excluded from the study.
Criteria used for ultrasonographic grading of hepatosteatosis were as follow.
Grade Ia : Phomogenous hyperechogenic changes in liver parenchyma are seen ( Figure 1).
Grade Ia': There is a homogenous hyperechogenity with fine and spark architecture (Figure 2).
Grade Ib : Hepatomegaly and thickening of the liver edge in addition to hyperdensity and excessive hyperechogenicity in liver architecture are detected (Figure 3).
Grade Ic : Hepatomegaly, thickening of the liver edge, uniform, dense and coarse excessively hyperechoic pattern (Figure 4).
Figure 3:
Figure 4:
Grade II : Dense hyperechogenity of the liver parenchyma, moderate nonhomogenous changes, punctutions and patchy hypoechoic regions, thickening of the liver edge and hepatomegaly are the typical findings (Figure 5)
Grade III: Nonhomogeneous hyperechogenictiy, coarse and patchy hypoechoic regions, regeneration nodules in the hyperechoic liver parenchyma, and thickening of the liver edge are defined. The sonographic findings indicat portal hypertension and ascites are also detected in this grade of fatty liver (Figure 6).
Criteria used for the histopathologic grading of hepatosteatosis were as follow.
Grade Ia : There is a moderate fat accumulation in the hepatocytes
Grade Ia': Centrolobular microvesicular steatosis of the hepatocytes and mild centrozonal necrosis are seen
Grade Ib : Severe fat accumulation in the hepatocytes, vascularizatition in the cytoplasm, cleaved nuclei and intercellular lipid cysts are demonstrated.
Garde Ic : Severe fat accumulation also occurs in other liver cells and cytoplasmic ballooning is seen in addition to the findings at grade Ib.
Grade II : Significant hepatocellular necrosis, mono nuclear infiltration, paracentral sclerosis and sinusoidal capillarization are the predominant findings. In addition to these findings, leucocyte infiltration, Mallory bodies and perisinusoidal colloid fibers are detected in chronic alcoholism .
Grade III: Significant degeneration of the liver parenchyma, fibrosis and regenerating nodules are seen, in addition to the findings seen in grade II.
In statistical analysis for the comparability tests we used kappa statistics and chi square, for trend test for testing the existence of linear trend on SGOT, SGPT, triglyceride and cholesterol (SPSS Statistical software Inc., Chicago 1990 ).
Figure 5:
Figure 6:
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