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Sonographic quantification of a Hepato-Renal Index for the assessment of hepatic steatosis in comparison with 3T proton magnetic resonance spectroscopy

Context Nonalcoholic fatty liver disease is the most frequent hepatic disorder in the developed world. Currently, liver biopsy and proton magnetic resonance spectroscopy (1H-MRS) are considered the gold standard methods for the quantification of liver fat deposits. Objective To determine whether a Sonographic Hepato-Renal Index (SHRI) calculated using a standard workstation, without a specifically designed software, is an adequate alternative to 1H-MRS for the quantification of fat liver content and diagnosis of steatosis in the general population. Methods A total of 121 volunteers (mean age=46 years, range=21–77 years) were recruited at three medical centers in Granada (Southern Spain) from among individuals attending routine general checkups. All participants were examined by ultrasound and by 1H-MRS 3T, which served as a reference for the diagnosis of steatosis. The SHRI was calculated as the ratio between the echogenicity of the liver and that of the right renal parenchyma. The validity of the methodology was assessed by receiver operating characteristic curves and correlation tests. Results The quantitative SHRI showed a strong correlation (Spearman’s coefficient=0.89, P<0.001) with the 1H-MRS 3T. The optimal SHRI cutoff points of 1.21, 1.28, and 2.15 yielded 100% sensitivity for the diagnoses of steatosis greater than 5, 25, and 50%, respectively, with a specificity greater than 70%. Conclusion This study shows that the SHRI is a valid, simple, reliable, and cost-effective screening tool for the identification, assessment, and quantification of hepatic steatosis in the general population.