Tagging incidental finding of fatty liver on ultrasound: A novel intervention to improve early detection of liver fibrosis.
liver fibrosis
nonalcoholic fatty liver disease
nonalcoholic steatohepatitis
risk factors
ultrasound
Journal
Journal of clinical and translational research
ISSN: 2424-810X
Titre abrégé: J Clin Transl Res
Pays: Singapore
ID NLM: 101667205
Informations de publication
Date de publication:
26 Oct 2021
26 Oct 2021
Historique:
received:
07
12
2020
revised:
08
09
2021
accepted:
09
09
2021
entrez:
15
11
2021
pubmed:
16
11
2021
medline:
16
11
2021
Statut:
epublish
Résumé
It is not uncommon to see that a large proportion of patients with cirrhosis due to nonalcoholic steatohepatitis never had any prior evaluation or diagnosis of liver disease, and most of the times their first clinical presentation is decompensated cirrhosis. Acknowledging incidental finding of fatty liver on abdominal imaging and identifying patients at risk of having advanced liver fibrosis may help in preventing its progression to cirrhosis. We aimed to increase acknowledgement and improve evaluation of steatosis through radiology recommendation to consider hepatology referral, and to identify the predictors of hepatology referral and significant fibrosis. We performed a retrospective study of 812 patients with hepatic steatosis tagged on ultrasound (US), over 18 months, at a single center. Patients with secondary causes of fatty liver were excluded from the study. We evaluated the yield of this intervention and factors correlated with hepatology referral and presence of significant fibrosis. Diagnosis of fatty liver was acknowledged for 69% of patients with tagged US, although only 29% were ultimately seen by hepatology. Patients who had US ordered by a primary care provider (PCP) were more likely to have hepatology evaluation (64.8% vs. 56.9%, Tagging US reports led to clinical acknowledgement of fatty liver in 7 of 10 patients, although fewer than 1 in 3 had further hepatology evaluation. Of those who underwent staging for incidentally noted steatosis, 18% had significant fibrosis, suggesting that we are failing to evaluate patients with potentially advanced liver disease. Identifying incidental finding of fatty liver on US provides a unique opportunity in diagnosing liver fibrosis at an early stage and can help prevent its progression to cirrhosis. PCP should consider using noninvasive scoring systems on a regular basis to assess the risk of fibrosis in patients with fatty liver, and timely referral to hepatology should be provided in patients at high risk of having advanced fibrosis.
Sections du résumé
BACKGROUND
BACKGROUND
It is not uncommon to see that a large proportion of patients with cirrhosis due to nonalcoholic steatohepatitis never had any prior evaluation or diagnosis of liver disease, and most of the times their first clinical presentation is decompensated cirrhosis. Acknowledging incidental finding of fatty liver on abdominal imaging and identifying patients at risk of having advanced liver fibrosis may help in preventing its progression to cirrhosis.
AIM
OBJECTIVE
We aimed to increase acknowledgement and improve evaluation of steatosis through radiology recommendation to consider hepatology referral, and to identify the predictors of hepatology referral and significant fibrosis.
METHODS
METHODS
We performed a retrospective study of 812 patients with hepatic steatosis tagged on ultrasound (US), over 18 months, at a single center. Patients with secondary causes of fatty liver were excluded from the study. We evaluated the yield of this intervention and factors correlated with hepatology referral and presence of significant fibrosis.
RESULTS
RESULTS
Diagnosis of fatty liver was acknowledged for 69% of patients with tagged US, although only 29% were ultimately seen by hepatology. Patients who had US ordered by a primary care provider (PCP) were more likely to have hepatology evaluation (64.8% vs. 56.9%,
CONCLUSIONS
CONCLUSIONS
Tagging US reports led to clinical acknowledgement of fatty liver in 7 of 10 patients, although fewer than 1 in 3 had further hepatology evaluation. Of those who underwent staging for incidentally noted steatosis, 18% had significant fibrosis, suggesting that we are failing to evaluate patients with potentially advanced liver disease.
RELEVANCE FOR PATIENTS
UNASSIGNED
Identifying incidental finding of fatty liver on US provides a unique opportunity in diagnosing liver fibrosis at an early stage and can help prevent its progression to cirrhosis. PCP should consider using noninvasive scoring systems on a regular basis to assess the risk of fibrosis in patients with fatty liver, and timely referral to hepatology should be provided in patients at high risk of having advanced fibrosis.
Identifiants
pubmed: 34778594
pii: jctres.07.202105.009
pmc: PMC8580527
Types de publication
Journal Article
Langues
eng
Pagination
641-647Informations de copyright
Copyright: © Whioce Publishing Pte. Ltd.
Déclaration de conflit d'intérêts
None of the authors have any conflicts of interest to disclose.
Références
Liver Int. 2013 Oct;33(9):1398-405
pubmed: 23763360
Clin Gastroenterol Hepatol. 2011 Jun;9(6):524-530.e1; quiz e60
pubmed: 21440669
Int J Mol Sci. 2016 May 20;17(5):
pubmed: 27213358
Hepatology. 2015 Dec;62(6):1723-30
pubmed: 26274335
Hepatology. 2018 Jan;67(1):328-357
pubmed: 28714183
J Med Imaging Radiat Oncol. 2019 Oct;63(5):573-579
pubmed: 31385415
Hepatology. 2003 Jun;37(6):1286-92
pubmed: 12774006
Ann Intern Med. 1997 Jan 15;126(2):137-45
pubmed: 9005748
J Med Imaging Radiat Oncol. 2019 Aug;63(4):431-438
pubmed: 30874372
Can J Gastroenterol Hepatol. 2016;2016:4930987
pubmed: 27446844
Gastroenterology. 2019 May;156(6):1717-1730
pubmed: 30689971
J Hepatol. 2004 Apr;40(4):578-84
pubmed: 15030972
Semin Liver Dis. 2012 Feb;32(1):3-13
pubmed: 22418883
Hepatol Int. 2016 Jul;10(4):632-9
pubmed: 26558795
Dig Dis Sci. 2015 Feb;60(2):333-8
pubmed: 25190263
Hepatology. 2017 May;65(5):1557-1565
pubmed: 28130788
JAMA. 2020 Mar 24;323(12):1175-1183
pubmed: 32207804
Annu Rev Med. 2017 Jan 14;68:85-98
pubmed: 27732787
Hepatology. 2014 Dec;60(6):1920-8
pubmed: 25103310
J Hepatol. 2018 Feb;68(2):238-250
pubmed: 29154966
Gastroenterology. 1994 Oct;107(4):1103-9
pubmed: 7523217
Clin Gastroenterol Hepatol. 2017 Sep;15(9):1453-1460.e1
pubmed: 28286195
Am J Gastroenterol. 2017 Jan;112(1):18-35
pubmed: 27995906