Masahide Hamaguchi, MD; Noriyuki Takeda, MD; Takao Kojima, MD
Potential Financial Conflicts of Interest: None disclosed.
Hamaguchi M., Takeda N., Kojima T.; The Metabolic Syndrome as a Predictor of Nonalcoholic Fatty Liver Disease. Ann Intern Med. 2006;144:380. doi: 10.7326/0003-4819-144-5-200603070-00023
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Published: Ann Intern Med. 2006;144(5):380.
Drs. Chavez-Tapia, Mendez-Sanchez, and Uribe argue that our study's lack of a second ultrasonographic evaluation by a different reviewer restricts the accuracy of the diagnosis of NAFLD. We understand that ultrasonography is not a perfect test and may lead to an incorrect diagnosis of NAFLD in many patients. However, as reported in the reference they quoted (1), interobserver variability is much greater than intraobserver variability for evaluation of the pattern and severity of NAFLD. The inclusion of a second reviewer would have decreased the power to detect longitudinal changes of ultrasonographic images. We believe that ultrasonographic interpretation by a single experienced gastroenterologist was a better approach for our longitudinal study.
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