Response to do ultrasonographic semiquantitative indices predict histological changes in NASH irrespective of steatosis extent?

efficacy of lifestyle changes (3). In agreement, a recent study showed that insulin resistance combined with a ultrasonographic fatty liver score accurately predicted NASH (4). To ascertain whether controlling for steatosis would weaken the association of ultrasonographic scores with NASH histological changes, we performed an additional analysis on our original data base. After controlling for steatosis grade, the association of US-FLI with lobular inflammation (q = 0.389, P = 0.004 adjusted) and NAS (q = 0.342, P = 0.013 adjusted) remained nevertheless significant. However, the correlations with ballooning and Brunt’s NASH grading of necroinflammatory activity went lost. Moreover, Bril found that intra and interobserver agreement, ‘substantial’ for the complete score, was ‘moderate’ for single items of the score (1). Interobserver agreement was all statistically significant ranking within the ‘almost perfect’ and ‘substantial’ categories in our study (2). Ultrasonographic scores, not recommended in differentiating NASH from simple steatosis non-invasively, are rather intended to help in selecting those patients to biopsy. Furthermore Bril enrolled a population at very high metabolic risk. Our series featured a 18/35 steatosis/NASH ratio and patients with simple steatosis tended to be overweight rather than obese and had a low prevalence of Metabolic Syndrome. The generalizability of future studies needs to take into account all the above parameters. In conclusion, given that ultrasonography is mandatory in NAFLD (5), ultrasonographic scores should be routinely adopted (2, 3). Accordingly, they need to be validated in cohorts of patients at low, intermediate, and high metabolic risk. Acknowledgements