Diffuse hepatic steatosis (grading)

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Grading of diffuse hepatic steatosis on ultrasound has been used to communicate to the clinician about the extent of fatty changes in the liver.

Grading

grade I: diffusely increased hepatic echogenicity but periportal and diaphragmatic echogenicity is still appreciable
grade II: diffusely increased hepatic echogenicity obscuring periportal echogenicity but diaphragmatic echogenicity is still appreciable
grade III: diffusely increased hepatic echogenicity obscuring periportal as well as diaphragmatic echogenicity

Practical points

It is important not to fall into the pitfall that all diffusely echogenic livers are fatty, other pathologies may produce identical appearances, including cirrhosis.

Some suggest that visual grading of hepatic steatosis is subject to a wide interobserver and intraobserver variability .

There is also a histological three point scale for grading severity of non-alcoholic steatohepatitis . These two grading systems are not currently correlated.