Sonographic assessment of fatty liver: intraobserver and interobserver variability.

Non-alcoholic fatty liver disease (NAFLD) is a common liver disease worldwide and ultrasonography is widely used in the diagnosis and the follow-up we purposed to assess intraobserver and interobserver variability in the sonographic evaluation of the existence and steatosis grades of NAFLD. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and AST to ALT (AST/ALT) ratio were compared between the grades of hepatosteatosis. Hepatic ultrasonography (US) examinations consisted of 5-10 static images of 113 successive adult patients, whose records were in the picture archiving and communication system (PACS) of our hospital were retrospectively evaluated by two experienced radiologists. Hepatic images were graded into 4 groups; as normal, mild, moderate or severe hepatic steatosis. Evaluation of hepatic steatosis of the same set of images was repeated after one month under the same conditions. Interobserver and intraobserver agreement was assessed by using kappa (κ) statistics. In each group, the percentage of individuals with high ALT and/or AST, or AST/ALT ratio over 1 was calculated. The intraobserver agreement was 51%, fair kappa (κ=0.356) for observer 1; and 68%, moderate (κ=0.591) for observer 2. The interobserver agreements in the initial and second readings were 39% and 40%, fair (κ=0.208) and (κ=0.225), respectively. Elevations of ALT and/or AST levels were similar between groups depending on the degree of hepatosteatosis among the patients. Visual assessment of NAFLD by ultrasonography has substantial interobserver variability, and reproducibility of results is limited. More objective imaging modalities are needed to evaluate the degree of hepatosteatosis.

Blue rubber bleb nevus syndrome: imaging of small bowel lesions with peroral CT enterography.

Blue rubber bleb nevus syndrome (BRBNS) is a rare entity that consists of multiple venous malformations involving several organ systems, particularly the skin and the gastrointestinal tract. The diagnosis is based on clinical findings; however, imaging is required to investigate the extent of involvement and complications. A 17-year-old patient, with multiple blue skin nevus, was admitted to the emergency room of our hospital with severe gastrointestinal bleeding and melena. Upper endoscopy showed two wine-color vascular lesions in the duodenum, and colonoscopy revealed multiple lesions in the colon. Peroral CT enterography demonstrated multiple (more than 30) contrast-enhanced polypoid small bowel lesions, ranging in size from 5 to 16 mm. Some lesions contained millimetric calcifications representing phleboliths. The patient also had three pancreatic lesions which showed homogenous enhancement on the delayed images. Our findings show that peroral CT enterography is useful to demonstrate the extent of small bowel lesions of BRBNS. This is the first report of pancreatic involvement of BRBNS.