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Pickhardt PJ, Blake GM, Moeller A, Garrett JW, Summers RM. Post-contrast CT liver attenuation alone is superior to the liver-spleen difference for identifying moderate hepatic steatosis. Eur Radiol 2024:10.1007/s00330-024-10816-2. [PMID: 38834787 DOI: 10.1007/s00330-024-10816-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To assess the diagnostic performance of post-contrast CT for predicting moderate hepatic steatosis in an older adult cohort undergoing a uniform CT protocol, utilizing hepatic and splenic attenuation values. MATERIALS AND METHODS A total of 1676 adults (mean age, 68.4 ± 10.2 years; 1045M/631F) underwent a CT urothelial protocol that included unenhanced, portal venous, and 10-min delayed phases through the liver and spleen. Automated hepatosplenic segmentation for attenuation values (in HU) was performed using a validated deep-learning tool. Unenhanced liver attenuation < 40.0 HU, corresponding to > 15% MRI-based proton density fat, served as the reference standard for moderate steatosis. RESULTS The prevalence of moderate or severe steatosis was 12.9% (216/1676). The diagnostic performance of portal venous liver HU in predicting moderate hepatic steatosis (AUROC = 0.943) was significantly better than the liver-spleen HU difference (AUROC = 0.814) (p < 0.001). Portal venous phase liver thresholds of 80 and 90 HU had a sensitivity/specificity for moderate steatosis of 85.6%/89.6%, and 94.9%/74.7%, respectively, whereas a liver-spleen difference of -40 HU and -10 HU had a sensitivity/specificity of 43.5%/90.0% and 92.1%/52.5%, respectively. Furthermore, livers with moderate-severe steatosis demonstrated significantly less post-contrast enhancement (mean, 35.7 HU vs 47.3 HU; p < 0.001). CONCLUSION Moderate steatosis can be reliably diagnosed on standard portal venous phase CT using liver attenuation values alone. Consideration of splenic attenuation appears to add little value. Moderate steatosis not only has intrinsically lower pre-contrast liver attenuation values (< 40 HU), but also enhances less, typically resulting in post-contrast liver attenuation values of 80 HU or less. CLINICAL RELEVANCE STATEMENT Moderate steatosis can be reliably diagnosed on post-contrast CT using liver attenuation values alone. Livers with at least moderate steatosis enhance less than those with mild or no steatosis, which combines with the lower intrinsic attenuation to improve detection. KEY POINTS The liver-spleen attenuation difference is frequently utilized in routine practice but appears to have performance limitations. The liver-spleen attenuation difference is less effective than liver attenuation for moderate steatosis. Moderate and severe steatosis can be identified on standard portal venous phase CT using liver attenuation alone.
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Affiliation(s)
- Perry J Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Alex Moeller
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - John W Garrett
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
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2
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Catania R, Jia L, Haghshomar M, Miller FH, Borhani AA. Detection of moderate hepatic steatosis on contrast-enhanced dual-source dual-energy CT: Role and accuracy of virtual non-contrast CT. Eur J Radiol 2024; 172:111328. [PMID: 38325187 DOI: 10.1016/j.ejrad.2024.111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE To investigate diagnostic accuracy of virtual non contrast (VNC) images, based on dual-source dual-energy CT (dsDECT), for detection of at least moderate steatosis and to define a threshold value to make this diagnosis on VNC. METHODS This single-institution retrospective study included patients who had multi-phasic protocol dsDECT. Regions of interests were placed in different segments of the liver and spleen on true non-contrast (TNC), VNC, and portal-venous phase (PVP) images. At least moderate steatosis was defined as liver attenuation (LHU) < 40 HU on TNC. Diagnostic performance of VNC to detect steatosis was determined and the new threshold was tested in a validation cohort. RESULTS 236 patients were included in training cohort. Mean liver attenuation values were 51.3 ± 10.8 HU and 58.1 ± 11.5 HU for TNC and VNC (p < 0.001), with a mean difference (VNC - TNC) of 6.8 ± 6.9 HU. Correlation between TNC and VNC was strong (r = 0.81, p < 0.001). The AUCs of LHU on VNC for detection of hepatic steatosis were 0.92 (95 % Cl: 0.86-0.98), 0.92 (95 % Cl: 0.87-0.97), 0.92 (95 % Cl: 0.86-0.99), 0.91 (95 % Cl: 0.84-0.97), and 0.87 (95 % Cl: 0.80-0.95) for entire liver, left lateral, left medial, right anterior, and right posterior segments, respectively. VNC had sensitivity/specificity of 100 % /42 % when using a threshold of 40 HU; they were 69 % and 95 %, respectively, when using optimized threshold of 46 HU. This threshold showed similar performance in validation cohort (n = 80). CONCLUSIONS Hepatic attenuation on VNC has promising performance for detection of at least moderate steatosis. Proposed threshold of 46 HU provides high specificity and moderate sensitivity to detect steatosis.
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Affiliation(s)
- Roberta Catania
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Arkes Family Pavilion, Suite 800, Chicago, IL 60611, United States.
| | - Leo Jia
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Arkes Family Pavilion, Suite 800, Chicago, IL 60611, United States.
| | - Maryam Haghshomar
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Arkes Family Pavilion, Suite 800, Chicago, IL 60611, United States.
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Arkes Family Pavilion, Suite 800, Chicago, IL 60611, United States.
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Arkes Family Pavilion, Suite 800, Chicago, IL 60611, United States.
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3
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Pickhardt PJ, Blake GM, Kimmel Y, Weinstock E, Shaanan K, Hassid S, Abbas A, Fox MA. Detection of Moderate Hepatic Steatosis on Portal Venous Phase Contrast-Enhanced CT: Evaluation Using an Automated Artificial Intelligence Tool. AJR Am J Roentgenol 2023; 221:748-758. [PMID: 37466185 DOI: 10.2214/ajr.23.29651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND. Precontrast CT is an established means of evaluating for hepatic steatosis; postcontrast CT has historically been limited for this purpose. OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance of portal venous phase postcontrast CT in detecting at least moderate hepatic steatosis using liver and spleen attenuation measurements determined by an automated artificial intelligence (AI) tool. METHODS. This retrospective study included 2917 patients (1381 men, 1536 women; mean age, 56.8 years) who underwent a CT examination that included at least two series through the liver. Examinations were obtained from an AI vendor's data lake of data from 24 centers in one U.S. health care network and 29 centers in one Israeli health care network. An automated deep learning tool extracted liver and spleen attenuation measurements. The reference for at least moderate steatosis was precontrast liver attenuation of less than 40 HU (i.e., estimated liver fat > 15%). A radiologist manually reviewed examinations with outlier AI results to confirm portal venous timing and identify issues impacting attenuation measurements. RESULTS. After outlier review, analysis included 2777 patients with portal venous phase images. Prevalence of at least moderate steatosis was 13.9% (387/2777). Patients without and with at least moderate steatosis, respectively, had mean postcontrast liver attenuation of 104.5 ± 18.1 (SD) HU and 67.1 ± 18.6 HU (p < .001); a mean difference in postcontrast attenuation between the liver and the spleen (hereafter, postcontrast liver-spleen attenuation difference) of -7.6 ± 16.4 (SD) HU and -31.8 ± 20.3 HU (p < .001); and mean liver enhancement of 49.3 ± 15.9 (SD) HU versus 38.6 ± 13.6 HU (p < .001). Diagnostic performance for the detection of at least moderate steatosis was higher for postcontrast liver attenuation (AUC = 0.938) than for the postcontrast liver-spleen attenuation difference (AUC = 0.832) (p < .001). For detection of at least moderate steatosis, postcontrast liver attenuation had sensitivity and specificity of 77.8% and 93.2%, respectively, at less than 80 HU and 90.5% and 78.4%, respectively, at less than 90 HU; the postcontrast liver-spleen attenuation difference had sensitivity and specificity of 71.4% and 79.3%, respectively, at less than -20 HU and 87.0% and 62.1%, respectively, at less than -10 HU. CONCLUSION. Postcontrast liver attenuation outperformed the postcontrast liver-spleen attenuation difference for detecting at least moderate steatosis in a heterogeneous patient sample, as evaluated using an automated AI tool. Splenic attenuation likely is not needed to assess for at least moderate steatosis on postcontrast images. CLINICAL IMPACT. The technique could promote early detection of clinically significant nonalcoholic fatty liver disease through individualized or large-scale opportunistic evaluation.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | | | | | | | | | - Ahmad Abbas
- Department of Radiology, Barzilai University Medical Center, Ashkelon, Israel
| | - Matthew A Fox
- Nanox-AI, Ltd., Neve Ilan, Israel
- Department of Radiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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4
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Arif-Tiwari H, Porter KK, Kamel IR, Bashir MR, Fung A, Kaplan DE, McGuire BM, Russo GK, Smith EN, Solnes LB, Thakrar KH, Vij A, Wahab SA, Wardrop RM, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Abnormal Liver Function Tests. J Am Coll Radiol 2023; 20:S302-S314. [PMID: 38040457 DOI: 10.1016/j.jacr.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Liver function tests are commonly obtained in symptomatic and asymptomatic patients. Various overlapping lab patterns can be seen due to derangement of hepatocytes and bile ducts function. Imaging tests are pursued to identify underlying etiology and guide management based on the lab results. Liver function tests may reveal mild, moderate, or severe hepatocellular predominance and can be seen in alcoholic and nonalcoholic liver disease, acute hepatitis, and acute liver injury due to other causes. Cholestatic pattern with elevated alkaline phosphatase with or without elevated γ-glutamyl transpeptidase can be seen with various causes of obstructive biliopathy. Acute or subacute cholestasis with conjugated or unconjugated hyperbilirubinemia can be seen due to prehepatic, intrahepatic, or posthepatic causes. We discuss the initial and complementary imaging modalities to be used in clinical scenarios presenting with abnormal liver function tests. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona.
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alice Fung
- Oregon Health & Science University, Portland, Oregon
| | - David E Kaplan
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; American Association for the Study of Liver Diseases
| | - Brendan M McGuire
- University of Alabama at Birmingham, Birmingham, Alabama, Primary care physician
| | | | - Elainea N Smith
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Lilja Bjork Solnes
- Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Abhinav Vij
- New York University Langone Medical Center, New York, New York
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Richard M Wardrop
- Cleveland Clinic, Cleveland, Ohio; American College of Physicians, Hospital Medicine
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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5
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Iodine Images in Dual-energy CT: Detection of Hepatic Steatosis by Quantitative Iodine Concentration Values. J Digit Imaging 2022; 35:1738-1747. [PMID: 35879495 DOI: 10.1007/s10278-022-00682-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022] Open
Abstract
Hepatic steatosis is a common condition and an early manifestation of a systemic metabolic syndrome. As of today, there is no broadly accepted method for the diagnosis of hepatic steatosis in contrast-enhanced CT images. This retrospective study evaluates the potential of quantitative iodine values in portal venous phase iodine images in dual-energy CT (DECT) by measuring iodine concentrations in regions of interest (ROI) and analyzing the absolute iodine concentration of the liver parenchyma as well as three different blood-normalized iodine concentrations in a study cohort of 251 patients. An independent two sample t-test (p < 0.05) was used to compare the iodine concentrations of healthy and fatty liver. Diagnostic performance was assessed by ROC (receiver operating characteristic) curve analysis. The results showed significant differences between the average iodine concentration of healthy and fatty liver parenchyma for the absolute and for the blood-normalized iodine concentrations. The study concludes that the iodine uptake of the liver parenchyma is impaired by hepatic steatosis, and that the measurement of iodine concentration can provide a suitable method for the detection of hepatic steatosis in quantitative iodine images. Suitable thresholds of quantitative iodine concentration values for the diagnosis of hepatic steatosis are provided.
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6
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The Relationship of Liver and Pancreas Density With Chest Computed Tomography Score Progression and Laboratory Findings in Patients With COVID-19. J Comput Assist Tomogr 2022; 46:848-853. [PMID: 35830381 PMCID: PMC9696684 DOI: 10.1097/rct.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abdominal involvement of COVID-19 is a current issue. We aimed to evaluate hepatic and pancreatic density alterations on computed tomography (CT) and to analyze whether these alterations had a relationship with chest CT score and laboratory findings.
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7
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Vilalta A, Gutiérrez JA, Chaves S, Hernández M, Urbina S, Hompesch M. Adipose tissue measurement in clinical research for obesity, type 2 diabetes and NAFLD/NASH. Endocrinol Diabetes Metab 2022; 5:e00335. [PMID: 35388643 PMCID: PMC9094496 DOI: 10.1002/edm2.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
| | - Julio A. Gutiérrez
- ProSciento San Diego California USA
- Scripps Center for Organ Transplantation La Jolla California USA
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8
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Xu JJ, Boesen MR, Hansen SL, Ulriksen PS, Holm S, Lönn L, Hansen KL. Assessment of Liver Fat: Dual-Energy CT versus Conventional CT with and without Contrast. Diagnostics (Basel) 2022; 12:diagnostics12030708. [PMID: 35328261 PMCID: PMC8946969 DOI: 10.3390/diagnostics12030708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/26/2022] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
We assessed the correlation between liver fat percentage using dual-energy CT (DECT) and Hounsfield unit (HU) measurements in contrast and non-contrast CT. This study included 177 patients in two patient groups: Group A (n = 125) underwent whole body non-contrast DECT and group B (n = 52) had a multiphasic DECT including a conventional non-contrast CT. Three regions of interest were placed on each image series, one in the left liver lobe and two in the right to measure Hounsfield Units (HU) as well as liver fat percentage. Linear regression analysis was performed for each group as well as combined. Receiver operating characteristic (ROC) curve was generated to establish the optimal fat percentage threshold value in DECT for predicting a non-contrast threshold of 40 HU correlating to moderate-severe liver steatosis. We found a strong correlation between fat percentage found with DECT and HU measured in non-contrast CT in group A and B individually (R2 = 0.81 and 0.86, respectively) as well as combined (R2 = 0.85). No significant difference was found when comparing venous and arterial phase DECT fat percentage measurements in group B (p = 0.67). A threshold of 10% liver fat found with DECT had 95% sensitivity and 95% specificity for the prediction of a 40 HU threshold using non-contrast CT. In conclusion, liver fat quantification using DECT shows high correlation with HU measurements independent of scan phase.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence:
| | - Mikkel Ranum Boesen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.R.B.); (S.L.H.); (S.H.)
| | - Sofie Lindskov Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.R.B.); (S.L.H.); (S.H.)
| | - Peter Sommer Ulriksen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
| | - Søren Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.R.B.); (S.L.H.); (S.H.)
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (P.S.U.); (L.L.); (K.L.H.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
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9
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Swelam A, Adam R, Lauka L, Basilio Rodrigues L, Elgarf S, Sebagh M, Golse N, Sa Cunha A, Cherqui D, Castaing D, Allard MA. A Model to Predict Significant Macrosteatosis in Hepatic Grafts. World J Surg 2020; 44:1270-1276. [PMID: 31858179 DOI: 10.1007/s00268-019-05330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Assessing the risk of significant macrosteatosis in donors is crucial before considering hepatic graft procurement. We aimed to build a model to predict significant macrosteatosis based on noninvasive methods. METHODS From January 2012 to December 2018, liver attenuation indices and liver-to-spleen (L/S) ratio were measured in 639 brain-dead donors by local radiologists. Quantity and quality of steatosis were evaluated by an expert pathologist, blinded for attenuation indices measurement. RESULTS Macrosteatosis ≥ 30% was found in 33 donors (5.2%). Body weight, body mass index (BMI), abdominal perimeters, history of alcohol abuse, L/S ratio, and liver parenchyma attenuation were associated with macrosteatosis ≥ 30%. The L/S ratio, BMI, and a history of alcohol abuse remained independent predictors in multivariate analysis and were used to build a predictive model (C-index: 0.77). The optimal cutoff to predict macrosteatosis ≥ 60% was 0.85. CONCLUSION Our model, including L/S ratio, BMI, and history of alcohol, might be helpful to refine indication for liver biopsy before donation after brain death. External validation is required.
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Affiliation(s)
- Ahmed Swelam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Gastrointestinal and HPB Surgery Department, Tanta University Hospital, Tanta, Egypt
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Unités Mixtes de Recherche en Santé 935, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Lelde Lauka
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France
| | - Luiza Basilio Rodrigues
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France
| | - Sherif Elgarf
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Gastrointestinal and HPB Surgery Department, Tanta University Hospital, Tanta, Egypt
| | - Mylène Sebagh
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France
| | - Nicolas Golse
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Unités Mixtes de Recherche en Santé 935, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Denis Castaing
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France.,Unités Mixtes de Recherche en Santé 1193, INSERM, Villejuif, France.,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 av Paul Vaillant Couturier, 94804, Villejuif Cedex, France. .,Unités Mixtes de Recherche en Santé 935, INSERM, Villejuif, France. .,Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France.
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10
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Liver Steatosis Categorization on Contrast-Enhanced CT Using a Fully Automated Deep Learning Volumetric Segmentation Tool: Evaluation in 1204 Healthy Adults Using Unenhanced CT as a Reference Standard. AJR Am J Roentgenol 2020; 217:359-367. [PMID: 32936018 DOI: 10.2214/ajr.20.24415] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Hepatic attenuation at unenhanced CT is linearly correlated with the MRI proton density fat fraction (PDFF). Liver fat quantification at contrast-enhanced CT is more challenging. OBJECTIVE. The purpose of this article is to evaluate liver steatosis categorization on contrast-enhanced CT using a fully automated deep learning volumetric hepatosplenic segmentation algorithm and unenhanced CT as the reference standard. METHODS. A fully automated volumetric hepatosplenic segmentation algorithm using 3D convolutional neural networks was applied to unenhanced and contrast-enhanced series from a sample of 1204 healthy adults (mean age, 45.2 years; 726 women, 478 men) undergoing CT evaluation for renal donation. The mean volumetric attenuation was computed from all designated liver and spleen voxels. PDFF was estimated from unenhanced CT attenuation and served as the reference standard. Contrast-enhanced attenuations were evaluated for detecting PDFF thresholds of 5% (mild steatosis, 10% and 15% (moderate steatosis); PDFF less than 5% was considered normal. RESULTS. Using unenhanced CT as reference, estimated PDFF was ≥ 5% (mild steatosis), ≥ 10%, and ≥ 15% (moderate steatosis) in 50.1% (n = 603), 12.5% (n = 151) and 4.8% (n = 58) of patients, respectively. ROC AUC values for predicting PDFF thresholds of 5%, 10%, and 15% using contrast-enhanced liver attenuation were 0.669, 0.854, and 0.962, respectively, and using contrast-enhanced liver-spleen attenuation difference were 0.662, 0.866, and 0.986, respectively. A total of 96.8% (90/93) of patients with contrast-enhanced liver attenuation less than 90 HU had steatosis (PDFF ≥ 5%); this threshold of less than 90 HU achieved sensitivity of 75.9% and specificity of 95.7% for moderate steatosis (PDFF ≥ 15%). Liver attenuation less than 100 HU achieved sensitivity of 34.0% and specificity of 94.2% for any steatosis (PDFF ≥ 5%). A total of 93.8% (30/32) of patients with contrast-enhanced liver-spleen attenuation difference 10 HU or less had moderate steatosis (PDFF ≥ 15%); a liver-spleen difference less than 5 HU achieved sensitivity of 91.4% and specificity of 95.0% for moderate steatosis. Liver-spleen difference less than 10 HU achieved sensitivity of 29.5% and specificity of 95.5% for any steatosis (PDFF ≥ 5%). CONCLUSION. Contrast-enhanced volumetric hepatosplenic attenuation derived using a fully automated deep learning CT tool may allow objective categoric assessment of hepatic steatosis. Accuracy was better for moderate than mild steatosis. Further confirmation using different scanning protocols and vendors is warranted. CLINICAL IMPACT. If these results are confirmed in independent patient samples, this automated approach could prove useful for both individualized and population-based steatosis assessment.
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11
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Comparison of computed tomography hepatic steatosis criteria for identification of abnormal liver function and clinical risk factors, in incidentally noted fatty liver. Eur J Gastroenterol Hepatol 2020; 32:216-221. [PMID: 31584463 DOI: 10.1097/meg.0000000000001502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Hounsfield Units (HU) to compare the various computed tomography (CT) criteria for diagnosing hepatic steatosis with laboratory liver function parameters, and clinical risk factors retrospectively, when hepatic steatosis was incidentally detected. METHODS Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study in 200 randomly selected patients who had either nonenhanced CT (NECT) or contrast-enhanced CT (CECT) studies with reported hepatic steatosis. The participants were matched to age, gender, and ethnicity with 200 patients without hepatic steatosis. For NECT, four different criteria have been proposed in the literature to diagnose fatty liver: (1) liver HU less than 48 HU; (2) ratio of liver to spleen HU less than 0.8; (3) HU difference between liver and spleen less than -10; and (4) hepatic vessel HU ≥ liver HU. For CECT, difference between liver and spleen HU, in portal venous phase, ≤ -20 to -25 HU. Serum glucose, aspartate aminotransferase (AST), amino alanine transferase (ALT), total bilirubin were documented. Clinical history and clinical risk factors were documented from the electronic health records. Matched analyses and Wilcoxon signed rank sum test analysis were performed for matched variables. RESULTS Fatty liver by NECT criteria 1 and 3 has statistically significant correlation with elevated glucose levels (P = 0.02). Similarly, fatty liver by 1, 3, and 4 NECT criteria showed statistically significant associations with higher levels of ALT and AST. There were statistically significant higher prevalence of diabetes mellitus (P = 0.003) and alcohol consumption (P ≤ 0.0001) in cases when compared with the controls. There was marginal significance in CT Dose Index between cases and controls (95% confidence interval: 0.98, 1.00; odds ratio 0.99), reflecting that cases had slightly higher BMI compared to their matched controls, thereby requiring slightly higher mA/mAs for imaging. CONCLUSION Particular NECT criteria for fatty liver are best at identification of abnormal liver function and certain comorbidities, in the setting of incidental fatty liver detection, This creates the potential for benefits of early detection in clinical management.
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Şeker M, Erol C, Sevmiş Ş, Saka B, Durur Karakaya A. Comparison of CT methods for determining graft steatosis in living donor liver transplantation. Abdom Radiol (NY) 2019; 44:2418-2429. [PMID: 30937504 DOI: 10.1007/s00261-019-01993-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic performance of non-enhanced computed tomography (NECT) and contrast-enhanced CT (CECT) attenuation indices in the assessment of hepatic steatosis by using biopsy as the reference standard. MATERIALS AND METHODS This retrospective study was approved by our Institutional Review Board. 55 Potential donors who underwent both NECT and triphasic CECT and core liver biopsy, were included the study. Average attenuation measurements that were obtained from multiple regions in liver, spleen, and psoas muscle on both unenhanced and CECT were used for analysis. Hepatic attenuation measurements were analyzed with and without normalization with the spleen and psoas muscle. Linear regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the statistical association between CT indices and steatosis at histology. RESULTS Linear regression analysis confirmed the strongest correlation between steatosis and normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT scan (R 0.821; R2 0.674 and R 0.816; R2 0.665, respectively). The use of ROC curve analysis also demonstrated that normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT showed high diagnostic performance regarding the qualitative distinction of steatosis (AUC values greater than 0.9). CONCLUSION Attenuation measurements of liver normalized with spleen on hepatic venous phase may be useful in evaluating steatosis in donor candidates with moderate to severe steatosis who are unacceptable for liver donation. In this manner unnecessary liver biopsy may be avoided in those donor candidates.
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Affiliation(s)
- Mehmet Şeker
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey.
| | - Cengiz Erol
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
| | - Şinasi Sevmiş
- Department of Surgery, Yeni Yuzyıl University, Gaziosmanpaşa, 34245, Istanbul, Turkey
| | - Burcu Saka
- Department of Pathology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
| | - Afak Durur Karakaya
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
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A gathering storm: HIV infection and nonalcoholic fatty liver disease in low and middle-income countries. AIDS 2019; 33:1105-1115. [PMID: 31045941 DOI: 10.1097/qad.0000000000002161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Despite the decreasing total incidence of liver-related deaths, liver disease remains one of the major non-AIDS causes of morbidity and mortality amongst people living with HIV, and a significant proportion of liver disease in these individuals can be attributed to nonalcoholic fatty liver disease (NAFLD). NAFLD in HIV infection is a growing problem in view of increasing life expectancy associated with the use of effective antiretroviral therapy (ART), wider uptake of ART and increasing rates of obesity in many Asian as well as western countries. The problem may be more pronounced in developing countries where there are limited resources available for mass screening and diagnosis of NAFLD. There is a small but growing body of literature examining NAFLD in the setting of HIV, with data from low and middle-income countries (LMICs) particularly lacking. Here, we review the cohort data on NAFLD in HIV, and discuss the risk factors, pathogenesis of hepatic steatosis, NAFLD and nonalcoholic steatohepatitis (NASH), diagnostic approaches and therapeutic options available for NAFLD in the setting of HIV, and the specific challenges of NAFLD in HIV for LMICs.
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Zhang YN, Fowler KJ, Hamilton G, Cui JY, Sy EZ, Balanay M, Hooker JC, Szeverenyi N, Sirlin CB. Liver fat imaging-a clinical overview of ultrasound, CT, and MR imaging. Br J Radiol 2018; 91:20170959. [PMID: 29722568 PMCID: PMC6223150 DOI: 10.1259/bjr.20170959] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic steatosis is a frequently encountered imaging finding that may indicate chronic liver disease, the most common of which is non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is implicated in the development of systemic diseases and its progressive phenotype, non-alcoholic steatohepatitis, leads to increased liver-specific morbidity and mortality. With the rising obesity epidemic and advent of novel therapeutics aimed at altering metabolism, there is a growing need to quantify and monitor liver steatosis. Imaging methods for assessing steatosis range from simple and qualitative to complex and highly accurate metrics. Ultrasound may be appropriate in some clinical instances as a screening modality to identify the presence of abnormal liver morphology. However, it lacks sufficient specificity and sensitivity to constitute a diagnostic modality for instigating and monitoring therapy. Newer ultrasound techniques such as quantitative ultrasound show promise in turning qualitative assessment of steatosis on conventional ultrasound into quantitative measurements. Conventional unenhanced CT is capable of detecting and quantifying moderate to severe steatosis but is inaccurate at diagnosing mild steatosis and involves the use of radiation. Newer CT techniques, like dual energy CT, show potential in expanding the role of CT in quantifying steatosis. MRI proton-density fat fraction is currently the most accurate and precise imaging biomarker to quantify liver steatosis. As such, proton-density fat fraction is the most appropriate noninvasive end point for steatosis reduction in clinical trials and therapy response assessment.
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Affiliation(s)
- Yingzhen N Zhang
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Gavin Hamilton
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Jennifer Y Cui
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Ethan Z Sy
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Michelle Balanay
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Jonathan C Hooker
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Nikolaus Szeverenyi
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Claude B Sirlin
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
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Abstract
Fatty liver disease is characterized histologically by hepatic steatosis, the abnormal accumulation of lipid in hepatocytes. It is classified into alcoholic fatty liver disease and nonalcoholic fatty liver disease, and is an increasingly important cause of chronic liver disease and cirrhosis. Assessing the severity of hepatic steatosis in these conditions is important for diagnostic and prognostic purposes, as hepatic steatosis is potentially reversible if diagnosed early. The criterion standard for assessing hepatic steatosis is liver biopsy, which is limited by sampling error, its invasive nature, and associated morbidity. As such, noninvasive imaging-based methods of assessing hepatic steatosis are needed. Ultrasound and computed tomography are able to suggest the presence of hepatic steatosis based on imaging features, but are unable to accurately quantify hepatic fat content. Since Dixon's seminal work in 1984, magnetic resonance imaging has been used to compute the signal fat fraction from chemical shift-encoded imaging, commonly implemented as out-of-phase and in-phase imaging. However, signal fat fraction is confounded by several factors that limit its accuracy and reproducibility. Recently, advanced chemical shift-encoded magnetic resonance imaging methods have been developed that address these confounders and are able to measure the proton density fat fraction, a standardized, accurate, and reproducible biomarker of fat content. The use of these methods in the liver, as well as in other abdominal organs such as the pancreas, adrenal glands, and adipose tissue will be discussed in this review.
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Chartampilas E. Imaging of nonalcoholic fatty liver disease and its clinical utility. Hormones (Athens) 2018; 17:69-81. [PMID: 29858854 DOI: 10.1007/s42000-018-0012-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/04/2017] [Indexed: 12/21/2022]
Abstract
The prevalence of nonalcoholic fatty liver disease has been continuously rising over the last three decades and is projected to become the most common indication for liver transplantation in the near future. Its pathophysiology and complex interplay with diabetes and the metabolic syndrome are not as yet fully understood despite growing scientific interest and research. Modern imaging techniques offer significant assistance in this field by enabling the study of the liver noninvasively and evaluation of the degree of both steatosis and fibrosis, and even in attempting to diagnose the presence of inflammation (steatohepatitis). The derived measurements are highly precise, accurate and reproducible, performing better than biopsy in terms of quantification. In this article, these imaging techniques are overviewed and their performance regarding diagnosis, stratification and monitoring are evaluated. Their expanding role both in the research arena and in clinical practice along with their limitations is also discussed.
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Comparison of correlations between lipid profile and different computed tomography fatty liver criteria in the setting of incidentally noted fatty liver on computed tomography examinations. Eur J Gastroenterol Hepatol 2017; 29:1389-1396. [PMID: 28957871 DOI: 10.1097/meg.0000000000000972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to compare the correlations between computed tomography (CT) criteria for hepatic steatosis and lipid profile values when hepatic steatosis is incidentally detected. PARTICIPANTS AND METHODS This is an institutional Review Board-approved, HIPPA-compliant, retrospective study of abdominal CT scans in 200 randomly selected patients who had either nonenhanced CT (NECT) or contrast-enhanced CT (CECT) studies with reported fatty liver. The participants were matched for age, sex, and ethnicity with 200 patients with nonfatty liver. For NECT, four different criteria have been proposed in the literature to diagnose fatty liver: (i) liver Hounsfield Units (HU) less than 48 HU, (ii) ratio of liver to spleen HU less than 0.8, (iii) HU difference between liver and spleen less than -10, and (iv) hepatic vessel HU greater than or equal to liver HU. For CECT, the criteria was attenuation difference between liver and spleen HU, in the portal venous phase of up to -20 to -25 HU. Laboratory results (low-density lipoprotein, high-density lipoprotein, triglycerides) were documented. Matched analyses and conditional logistic regression analysis were carried out for matched variables. RESULTS There were statistically significant differences in triglyceride values, between the cases and controls (P=0.02), when all criteria were considered. Also, statistically significant differences were found between cases and controls on the basis of NECT criterion 2 and high-density lipoprotein (P=0.04), as well as CECT criteria and triglyceride levels (P=0.02). In addition, the data indicate that criteria for steatosis on CECT may be more broad than traditionally utilized. CONCLUSION Incidental reporting of fatty liver on NECT/CECT should prompt consideration of clinical follow-up and lipid profile testing in an otherwise asymptomatic patient. Additional metrics for the diagnosis of steatosis in CECT exam should also be considered.
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How to Perform Selective Liver Biopsy in Living Liver Donors Using Plain Computed Tomography. Transplantation 2017; 100:2398-2403. [PMID: 27495764 DOI: 10.1097/tp.0000000000001412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preoperative donor liver biopsy is the criterion standard to verify the quality of a liver. However, it can cause some complications, thus this study was designed to know whether selective liver biopsy is possible or not, and to find a subgroup that does not require preoperative biopsy. METHODS We reviewed preoperative images and postoperative outcome in 118 donors from September 2013 to January 2014. Visual grading of steatosis on plain computed tomography (CT) was performed and compared steatosis on preoperative liver biopsy was done within 7 days from the CT scan. RESULTS Visual grades of plain CT were 1 (n = 50, 42.4%), 2 (n = 47, 39.8%), 3 (n = 13, 11.0%), 4 (n = 7, 5.9%), and 1 (n = 1, 0.8%). Macrovesicular steatosis on liver biopsy according to visual grades were 1 (0.67 ± 1.3%), 2 (1.67 ± 1.8%), 3 (6.23 ± 6.4%), 4 (14.7 ± 16.6), and 5 (30%). Right liver grafts including right lobe, modified right lobe, and extended right lobe were procured in 106 (89.9%) donors, and 16% (17/106) of the donors were visual grades 3, 4, and 5. Eleven donors (64.7%) were accepted for right liver donation after liver biopsy, whereas 6 (35.3%) donors were deemed possible to donate right liver after weight reduction and reevaluation of steatosis. Transient hepatic dysfunction after right hepatectomy was significantly increased according to the increment of visual grade. CONCLUSIONS Preoperative liver biopsy may not be necessary in visual grade 1 or 2 donors, but should be performed for grade 3 and 4 donors based on recipient's urgency so as to decide whether to proceed with right hepatectomy or not.
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Venkatesh SK, Hennedige T, Johnson GB, Hough DM, Fletcher JG. Imaging patterns and focal lesions in fatty liver: a pictorial review. Abdom Radiol (NY) 2017; 42:1374-1392. [PMID: 27999887 DOI: 10.1007/s00261-016-1002-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease and affects nearly one-third of US population. With the increasing trend of obesity in the population, associated fatty change in the liver will be a common feature observed in imaging studies. Fatty liver causes changes in liver parenchyma appearance on imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) and may affect the imaging characteristics of focal liver lesions (FLLs). The imaging characteristics of FLLs were classically described in a non-fatty liver. In addition, focal fatty change and focal fat sparing may also simulate FLLs. Knowledge of characteristic patterns of fatty change in the liver (diffuse, geographical, focal, subcapsular, and perivascular) and their impact on the detection and characterization of FLL is therefore important. In general, fatty change may improve detection of FLLs on MRI using fat suppression sequences, but may reduce sensitivity on a single-phase (portal venous) CT and conventional ultrasound. In patients with fatty liver, MRI is generally superior to ultrasound and CT for detection and characterization of FLL. In this pictorial essay, we describe the imaging patterns of fatty change in the liver and its effect on detection and characterization of FLLs on ultrasound, CT, MRI, and PET.
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20
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Lăpădat AM, Jianu IR, Ungureanu BS, Florescu LM, Gheonea DI, Sovaila S, Gheonea IA. Non-invasive imaging techniques in assessing non-alcoholic fatty liver disease: a current status of available methods. J Med Life 2017. [DOI: 10.25122/jml-2017-0019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an ailment affecting and increasing a number of people worldwide diagnosed via non-invasive imaging techniques, at a time when a minimum harm caused by medical procedures is rightfully emphasized, more sought after, than ever before. Liver steatosis should not be taken lightly even if its evolution is largely benign as it has the potential to develop into non-alcoholic steatohepatitis (NASH) or even more concerning, hepatic cirrhosis, and hepatocellular carcinoma (HCC). Traditionally, liver biopsy has been the standard for diagnosing this particular liver disease, but nowadays, a consistent number of imagistic methods are available for diagnosing hepatosteatosis and choosing the one appropriate to the clinical context is the key. Although different in sensitivity and specificity when it comes to determining the hepatic fat fraction (FF), these imaging techniques possessing a diverse availability, operating difficulty, cost, and reproducibility are invaluable to any modern physician. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), elastography, and spectroscopy will be discussed in order to lay out the advantages and disadvantages of their diagnostic potential and application.Although imagistics has given physicians a valuable insight into the means of managing NAFLD, the current methods are far from perfect, but given the time, they will surely be improved and the use of liver biopsy will be completely removed.
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Matsuo T, Ushiroda Y. Fatty liver formation in fulminant type 1 diabetes. Endocrinol Diabetes Metab Case Rep 2016; 2016:15-0121. [PMID: 30367750 PMCID: PMC6356111 DOI: 10.1530/edm-15-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 32-year-old woman presented with 3days of epigastric pain and was admitted to our hospital (day 3 of disease). We diagnosed acute pancreatitis based on epigastric abdominal pain, hyperamylasemia, and an inflammatory reaction of withdrawn blood, pancreatic enlargement, and so on. Her condition improved with treatment; however, on day 8, she had decreased level of consciousness. Laboratory results led to a diagnosis of fulminant type 1 diabetes mellitus (FT1DM) with concomitant diabetic ketoacidosis. Insulin therapy improved her blood glucose levels as well as her symptoms. Fatty liver with liver dysfunction was observed on day 14, which improved by day 24. Blood levels of free fatty acids (FFAs) increased rapidly from 440μEq/L (normal range: 140–850μEq/L) on day 4 to 2097μEq/L on days 7–8 (onset of FT1DM) and subsequently decreased to 246μEq/L at the onset of fatty liver. The rapid decrease in insulin at the onset of FT1DM likely freed fatty acids derived from triglycerides in peripheral adipocytes into the bloodstream. Insulin therapy rapidly transferred FFAs from the periphery to the liver. In addition, insulin promotes the de novo synthesis of triglycerides in the liver, using newly acquired FFAs as substrates. At the same time, inhibitory effects of insulin on VLDL secretion outside of the liver promote the accumulation of triglycerides in the liver, leading to fatty liver. We describe the process by which liver dysfunction and severe fatty liver occurs after the onset of FT1DM, from the perspective of disturbed fatty acid metabolism.
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Affiliation(s)
- Takashi Matsuo
- Internal Medicine, Nobeoka city Medical Association Hospital, Nobeoka, Japan
| | - Yoshihiko Ushiroda
- Internal Medicine, Nobeoka city Medical Association Hospital, Nobeoka, Japan
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22
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Abstract
Conventional imaging modalities, including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR), play an important role in the diagnosis and management of patients with nonalcoholic fatty liver disease (NAFLD) by allowing noninvasive diagnosis of hepatic steatosis. However, conventional imaging modalities are limited as biomarkers of NAFLD for various reasons. Multi-parametric quantitative MRI techniques overcome many of the shortcomings of conventional imaging and allow comprehensive and objective evaluation of NAFLD. MRI can provide unconfounded biomarkers of hepatic fat, iron, and fibrosis in a single examination-a virtual biopsy has become a clinical reality. In this article, we will review the utility and limitation of conventional US, CT, and MR imaging for the diagnosis NAFLD. Recent advances in imaging biomarkers of NAFLD are also discussed with an emphasis in multi-parametric quantitative MRI.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Scott B Reeder
- Department of Radiology, Medical Physics, Biomedical Engineering, Medicine, Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Takeshi Yokoo
- Department of Radiology and Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
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Olefson S, Jackson M, Grand DJ, Charpentier KP, Makwana N, Promrat K. Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique. J Clin Transl Hepatol 2015; 3:246-53. [PMID: 26807379 PMCID: PMC4721891 DOI: 10.14218/jcth.2015.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS While traditional risk factors for the development of nonalcoholic fatty liver disease (NAFLD) relate to metabolic syndrome, several Asian studies have suggested a high rate of de novo NAFLD following pancreaticoduodenectomy (PD). The aim of this study is to identify de novo NAFLD after pancreatic surgery and its associated risk factors. METHODS A retrospective cohort of patients at a single center that underwent PD or distal pancreatectomy (DP) over 7 years was identified. Pre- and postoperative contrast-enhanced computed tomography scans of the abdomen were reviewed, including attenuation measurements of the liver, spleen, and muscle. Primary outcomes included hepatic attenuation, liver to muscle ratio (LMR), and liver to spleen ratio (LSR). RESULTS Of the 96 patients (mean age 64.3) included, 70% underwent PD, and 30% underwent DP. The mean LMR decreased significantly from 1.81 to 1.66 (p=0.02), noted only in men. No interaction effect with LMR was observed with surgical type, chemotherapy, blood loss, pancreatic enzyme replacement, or transaminases. LMR decreased in 55% of subjects. CONCLUSIONS Increased fatty infiltration, as evidence by decreased LMR, was found among men that underwent PD and DP within a year of surgery. This may be related to weight loss and malabsorption and deserves further investigation.
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Affiliation(s)
- Sidney Olefson
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Melissa Jackson
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David J. Grand
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin P. Charpentier
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nirav Makwana
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kittichai Promrat
- Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Correspondence to: Kittichai Promrat, Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. Tel: +1-401-444-3575, Fax: +1-401-444-6316, E-mail:
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Sagir Kahraman A, Karakas HM, Kirimlioglu H, Kahraman B, Yilmaz S, Kirimlioglu V. The Assessment of Hepatosteatosis in Living-Donor Liver Transplant: Comparison of Liver Attenuation Index and Histopathologic Results. EXP CLIN TRANSPLANT 2015. [PMID: 26221870 DOI: 10.6002/ect.2015.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The purpose of the study was to determine the diagnostic value of computed tomography densitometry in the quantification of hepatosteatosis. MATERIALS AND METHODS Fifty-one potential liver donors, ranging in age from 19 to 52 years (mean age: 32.4 years ± 10.2), participated in the study. The mean hepatic attenuation and mean splenic attenuation were determined using regions of interest measurements. The difference between the mean hepatic attenuation and mean splenic attenuation (or liver attenuation index), with liver attenuation index = mean hepatic attenuation - mean splenic attenuation were calculated. Computed tomography densitometric parameters were correlated with histopathologic results. RESULTS From the histopathologic analysis, the degree of macrovesicular hepatosteatosis was 0% to 8% (mean: 1.1% ± 2%). Seven donors (13.7%) had a degree of macrovesicular steatosis of > 5%, and 12 donors (23.5%) had ≥ 2%. Of the 29 normal donors with histopathologic verification, computed tomography densitometry predicted ≤ 5% of the hepatosteatosis in 27 donors, and ≤ 2% hepatosteatosis in 2 subjects. The liver attenuation index was significantly correlated to the histopathologic results. The mathematical relation between liver attenuation index and the degree of histopathologic hepatosteatosis was calculated using the least-squares methods, which provided quadratic polynomials. CONCLUSIONS Computed tomography densitometry is a rapid, robust, noninvasive technique for the assessment of hepatosteatosis. When used in conjunction with clinically stable reference measurements of spleen, the density measurements of liver correctly predicted the presence of fatty infiltration with significant sensitivity (77%) and specificity (75%). This technique, which was refined during the course of our liver transplant program, minimizes the need for highly invasive percutaneous liver biopsies.
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AlShaalan R, Aljiffry M, Al-Busafi S, Metrakos P, Hassanain M. Nonalcoholic fatty liver disease: Noninvasive methods of diagnosing hepatic steatosis. Saudi J Gastroenterol 2015; 21:64-70. [PMID: 25843191 PMCID: PMC4392577 DOI: 10.4103/1319-3767.153812] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hepatic steatosis is the buildup of lipids within hepatocytes. It is the simplest stage in nonalcoholic fatty liver disease (NAFLD). It occurs in approximately 30% of the general population and as much as 90% of the obese population in the United States. It may progress to nonalcoholic steatohepatitis, which is a state of hepatocellular inflammation and damage in response to the accumulated fat. Liver biopsy remains the gold standard tool to diagnose and stage NAFLD. However, it comes with the risk of complications ranging from simple pain to life-threatening bleeding. It is also associated with sampling error. For these reasons, a variety of noninvasive radiological markers, including ultrasound, computed tomography, magnetic resonance spectroscopy, and the controlled attenuation parameter using transient elastography and Xenon-133 scan have been proposed to increase our ability to diagnose NAFLD, hence avoiding liver biopsy. The aim of this review is to discuss the utility and accuracy of using available noninvasive diagnostic modalities for fatty liver in NAFLD.
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Affiliation(s)
- Rasha AlShaalan
- Department of Surgery, Section of Hepatobiliary and Transplant Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Murad Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Said Al-Busafi
- Department of Medicine, Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Peter Metrakos
- Department of Surgery, Section of Hepatobiliary and Transplant Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Mazen Hassanain
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia,Department of Oncology, McGill University Health Center, Montreal Quebec, Canada,Address for correspondence: Dr. Mazen Hassanain, HPB, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, S 10.26, H3A 1A1, Montreal, QC, Canada. E-mail:
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Yoo DG, Jung BH, Hwang S, Kim SC, Kim KH, Lee YJ, Ahn CS, Moon DB, Kim KM, Ha TY, Kang SH, Kim N. Prevalence analysis of de novo hepatic steatosis following pylorus-preserving pancreaticoduodenectomy. Dig Surg 2014; 31:359-65. [PMID: 25503526 DOI: 10.1159/000368381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prevalence of hepatic steatosis following pylorus-preserving pancreaticoduodenectomy (PPPD) is high. This study intended to reveal the prevalence and patterns of de novo hepatic steatosis following PPPD. METHODS We investigated postoperative de novo hepatic steatosis following PPPD (n = 101) with a control group of bile duct resection (BDR) (n = 54). RESULTS At postoperative 1 year, hepatic steatosis occurred in 21 of 82 patients (25.6%) of PPPD group and in 2 of 47 patients (4.3%) of BDR group (p = 0.001). Thereafter, at 2 to 5 years, a high prevalence of hepatic steatosis persisted in the PPPD group, but no further occurrence developed in BDR group. Once steatosis developed, it persisted until the end of the study period or patient death. Five-year cumulative incidence of hepatic steatosis was 26.7% in the PPPD group and 3.7% in BDR group (p < 0.001). Univariate analyses showed that patient sex, age, body mass index, blood lipid profile, recurrence of tumor, and diabetes did not have significant influence on the development of hepatic steatosis following PPPD. CONCLUSIONS De novo hepatic steatosis may develop in a not negligible proportion of patients undergone PPPD. Multicenter studies with a high number of patients are needed to elucidate its pathogenesis and to find effective treatment for pancreaticoduodenectomy-associated hepatic steatosis.
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Affiliation(s)
- Dae-Gwang Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
Preoperative evaluation of donors for living-donor liver transplantation aims to select a suitable donor with optimal graft quality and to ensure donor safety. Hepatic steatosis, a common finding in living liver donors, not only influences the outcome of liver transplantation for the recipient but also affects the recovery of the living donor after partial hepatectomy. Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but it is invasive, and results are vulnerable to sampling error. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error. Selection of appropriate imaging methods demands understanding of their advantages and limitations and the suitable clinical setting. This article describes potential clinical applications for liver fat quantification of imaging methods for fat detection and quantification, with an emphasis on the advantages and limitations of ultrasonography, computed tomography, and magnetic resonance imaging for quantifying liver fat.
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Quantification of the Fat Fraction in the Liver Using Dual-Energy Computed Tomography and Multimaterial Decomposition. J Comput Assist Tomogr 2014; 38:845-52. [DOI: 10.1097/rct.0000000000000142] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Monjardim RDF, Costa DMC, Romano RFT, Salvadori PS, Santos JDVCD, Atzingen ACV, Shigueoka DC, D'Ippolito G. Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000300005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and Methods In the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L - 0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results The simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity.
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Detection of hepatic steatosis on contrast-enhanced CT images: diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol 2012; 199:44-7. [PMID: 22733892 DOI: 10.2214/ajr.11.7838] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to determine the diagnostic accuracy of identifying focal areas of increased density along the gallbladder fossa or in the periphery of segment IV for diagnosing hepatic steatosis. MATERIALS AND METHODS Five hundred consecutive three-phase CT examinations were retrospectively evaluated. Two reference standards for hepatic steatosis were determined using the unenhanced CT examination: a liver-spleen attenuation difference of greater than 10 HU and the absolute attenuation of the liver less than 40 HU. The portal venous phase was independently analyzed by two radiologists. Hepatic steatosis was diagnosed on the contrast-enhanced images if there was increased attenuation in the liver, either at the gallbladder fossa or in the posterior medial aspect of segment IV, when compared with background liver parenchyma. RESULTS The criterion of relative liver-spleen attenuation difference diagnosed 38 cases. The criterion of absolute liver attenuation less than 40 HU diagnosed 44 cases. Of these cases, hepatic steatosis was diagnosed on the portal venous phase in 23 cases (κ = 1.0), with no false-positive cases. The criterion of relative liver-spleen attenuation difference yielded sensitivity, specificity, positive predictive value, and negative predictive value of 60.5%, 100%, 100%, and 96.9%, respectively. The criterion of absolute liver attenuation less than 40 HU yielded sensitivity, specificity, positive predictive value, and negative predictive value of 52.5%, 100%, 100%, and 95.7%, respectively. CONCLUSION Qualitative evaluation of the liver on a portal venous phase contrast-enhanced CT is highly specific for the diagnosis of hepatic steatosis; the sensitivity of the method, however, is rather low.
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Abstract
Nonalcoholic bland steatosis and nonalcoholic steatohepatitis (NASH) are stages in the spectrum of nonalcoholic fatty liver disease (NAFLD). NASH may progress to end-stage liver disease. Liver biopsy distinguishes between patients with NASH and no NASH and can stage fibrosis. Markers of hepatocyte apoptosis hold promise as noninvasive tests for NASH diagnosis. Several scoring systems that combine routine clinical and laboratory variables and some proprietary panels can assist in predicting fibrosis severity. Noninvasive imaging modalities are reasonably accurate available tools to determine severity of fibrosis in NAFLD, but none of them yet can replace liver biopsy.
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Affiliation(s)
- Garfield A Grandison
- Division of Digestive Diseases & Nutrition, Department of Medicine, University of Kentucky Medical Center, Lexington, 40536-0298, USA
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Ringe KI, Ringe BP, von Falck C, Shin HO, Becker T, Pfister ED, Wacker F, Ringe B. Evaluation of living liver donors using contrast enhanced multidetector CT - The radiologists impact on donor selection. BMC Med Imaging 2012; 12:21. [PMID: 22828359 PMCID: PMC3427040 DOI: 10.1186/1471-2342-12-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/24/2012] [Indexed: 01/10/2023] Open
Abstract
Background Living donor liver transplantation (LDLT) is a valuable and legitimate treatment for patients with end-stage liver disease. Computed tomography (CT) has proven to be an important tool in the process of donor evaluation. The purpose of this study was to evaluate the significance of CT in the donor selection process. Methods Between May 1999 and October 2010 170 candidate donors underwent biphasic CT. We retrospectively reviewed the results of the CT and liver volumetry, and assessed reasons for rejection. Results 89 candidates underwent partial liver resection (52.4%). Based on the results of liver CT and volumetry 22 candidates were excluded as donors (31% of the cases). Reasons included fatty liver (n = 9), vascular anatomical variants (n = 4), incidental finding of hemangioma and focal nodular hyperplasia (n = 1) and small (n = 5) or large for size (n = 5) graft volume. Conclusion CT based imaging of the liver in combination with dedicated software plays a key role in the process of evaluation of candidates for LDLT. It may account for up to 1/3 of the contraindications for LDLT.
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Affiliation(s)
- Kristina Imeen Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str, 1, 30625, Hannover, Germany.
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Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ. Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis. Acad Radiol 2012; 19:811-8. [PMID: 22521729 DOI: 10.1016/j.acra.2012.02.022] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 02/21/2012] [Accepted: 02/23/2012] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES Fatty liver disease is a common clinical entity in hepatology practice. This study evaluates the prevalence and reproducibility of computed tomography (CT) measures for diagnosis of fatty liver and compares commonly used CT criteria for the diagnosis of liver fat. MATERIALS AND METHODS The study includes 6814 asymptomatic participants from a population-based sample. The ratio of liver-to-spleen (L/S) Hounsfield units (HU) <1.0 and liver attenuation <40 HU were used for diagnosing and assessing the severity of liver fat content. Participants with heavy alcohol intake (>7 drinks/week for women and >14 drinks/week for men) were excluded. Final analysis was performed on participants where images of both liver and spleen were available on the scans. RESULTS The overall prevalence of fatty liver (4175 subjects included in final analysis) was 17.2% (using L/S ratio <1.0), with 6.3% (with <40 HU cutoff) of the population having moderate to severe steatosis (>30% liver fat content). The prevalence was high in participants with dyslipidemia (70.4%), hypertension (56.8%), and obesity (53%). Diabetic patients had 24.1% prevalence of fatty liver. The prevalence provided by L/S ratio <1.0 (17.2%) was comparable to prevalence provided by <51 HU (17.3%), whereas prevalence obtained by <40 HU (6.3%) cutoff corresponded to L/S ratio of <0.8 (6.5%). The measurements of liver and spleen HU attenuations were highly reproducible (0.96, 0.99 and 0.99, 0.99 for intra- and inter-reader variability, respectively) in a sample of 100 scans. CONCLUSION Fatty liver can be reliably diagnosed using nonenhanced CT scans.
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Affiliation(s)
- Irfan Zeb
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA.
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Normal liver tissue density dose response in patients treated with stereotactic body radiation therapy for liver metastases. Int J Radiat Oncol Biol Phys 2012; 84:e441-6. [PMID: 22682809 DOI: 10.1016/j.ijrobp.2012.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/25/2012] [Accepted: 04/27/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the temporal dose response of normal liver tissue for patients with liver metastases treated with stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS Ninety-nine noncontrast follow-up computed tomography (CT) scans of 34 patients who received SBRT between 2004 and 2011 were retrospectively analyzed at a median of 8 months post-SBRT (range, 0.7-36 months). SBRT-induced normal liver tissue density changes in follow-up CT scans were evaluated at 2, 6, 10, 15, and 27 months. The dose distributions from planning CTs were mapped to follow-up CTs to relate the mean Hounsfield unit change (ΔHU) to dose received over the range 0-55 Gy in 3-5 fractions. An absolute density change of 7 HU was considered a significant radiographic change in normal liver tissue. RESULTS Increasing radiation dose was linearly correlated with lower post-SBRT liver tissue density (slope, -0.65 ΔHU/5 Gy). The threshold for significant change (-7 ΔHU) was observed in the range of 30-35 Gy. This effect did not vary significantly over the time intervals evaluated. CONCLUSIONS SBRT induces a dose-dependent and relatively time-independent hypodense radiation reaction within normal liver tissue that is characterized by a decrease of >7 HU in liver density for doses >30-35 Gy.
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Husarik DB, Boll DT, Nelson RC, Merkle EM. Low-dose unenhanced CT for IV contrast bolus timing: is it reliable to assess hepatic steatosis? Acad Radiol 2011; 18:822-7. [PMID: 21530330 DOI: 10.1016/j.acra.2011.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 01/18/2011] [Accepted: 02/05/2011] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether an unenhanced low-dose image acquired during automated contrast bolus timing can be used to assess hepatic steatosis. MATERIALS AND METHODS Fifty subjects (29 male, 21 female; 26-92 years; mean body mass index (BMI; 26.9) with abdominal multiphasic computed tomography were included. Abdominal diameters and circumferences were derived from anteroposterior and lateral scout radiographs. Hepatic attenuation (HA) was measured on unenhanced low-dose images (120 kV; 40 mA; 0.5 seconds' rotation time) and corresponding unenhanced standard-dose images (120 kV, z-axis automatic tube current modulation, noise index 11.5). Noise estimates were measured in surrounding air. Pearson correlation was calculated between abdominal circumference and BMI. Mean HA assessed on low-dose images and standard-dose images was compared using a paired Student's t-test and Bland Altman plots. RESULTS Abdominal circumference (mean, 142.8cm) correlated well with BMI (r = 0.83). No significant difference was found for HA on low-dose images (mean +57.7 HU) compared to HA on standard-dose images (+56.0 HU) (P = .077). Image noise (+11.5 HU) was significantly higher on low-dose images compared to image noise (+8.1 HU) on standard-dose images (P < .05). For HA mean difference comparing low- and standard-dose images was -1.7 HU (limits of agreement: -14.6, 11.2). CONCLUSION In all subjects, hepatic attenuation can be correctly assessed on unenhanced low-dose images.
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Clark TJ, Cardoza S, Kanth N. Splenic trauma: pictorial review of contrast-enhanced CT findings. Emerg Radiol 2011; 18:227-34. [DOI: 10.1007/s10140-010-0933-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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Park YS, Park SH, Lee SS, Kim DY, Shin YM, Lee W, Lee SG, Yu ES. Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology 2011; 258:760-6. [PMID: 21212369 DOI: 10.1148/radiol.10101233] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To establish the reference range for hepatic attenuation minus splenic attenuation difference (CT(L-S)) values on nonenhanced computed tomographic (CT) images obtained in adults with a biopsy-proved nonsteatotic liver and determine the CT(L-S) criterion for diagnosing hepatic steatosis. MATERIALS AND METHODS This retrospective study was institutional review board approved, and all subjects had provided written informed consent. The CT(L-S) was measured in 315 liver donor candidates (207 men, 108 women; mean age, 31.5 years ± 10.1 [standard deviation]) who underwent nonenhanced CT of the liver and subsequent ultrasonographically guided liver biopsy on the same day. Nonenhanced liver CT was performed with a 16-section multidetector scanner in 154 individuals and with a 64-section multidetector scanner in 161 individuals. Biopsy specimens were analyzed for degree of hepatic steatosis and iron deposition. The CT(L-S) reference range was determined according to Clinical and Laboratory Standards Institute guideline C28-A3 in individuals with a histologically proved nonsteatotic liver. The sensitivity of nonenhanced CT for the diagnosis of 5% or greater and 30% or greater hepatic steatosis with use of the lower limit of the reference range as the diagnostic cutoff was determined. The effects of subject age and sex, CT scanner type, and hepatic iron on the CT(L-S) were evaluated by using multiple linear regression analysis. RESULTS Ninety-six subjects (48 men, 48 women) were found to have a histologically proved nonsteatotic liver, with an estimated reference range for CT(L-S) values of 1-18 HU. With a CT(L-S) of less than 1 HU as the criterion for hepatic steatosis, the sensitivities of nonenhanced CT for 5% or greater and 30% or greater hepatic steatosis were 18.6% (29 of 156 subjects) and 67% (26 of 39 subjects), respectively. Subject age had a significant but negligible effect on CT(L-S) (0.076-HU increase per year of age, P = .009), subject sex and scanner type had no effects on CT(L-S), and hepatic iron deposition significantly increased the CT(L-S) (1.434-HU increase per increase in iron deposition grade, P = .011). CONCLUSION The histologically proved reference range of CT(L-S) values for nonsteatotic livers was 1-18 HU. A CT(L-S) of less than 1 HU could be used as a conservative criterion for diagnosing hepatic steatosis with nonenhanced CT more consistently.
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Affiliation(s)
- Yang Shin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, Korea
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Esteghamati A, Jamali A, Khalilzadeh O, Noshad S, Khalili M, Zandieh A, Morteza A, Nakhjavani M. Metabolic syndrome is linked to a mild elevation in liver aminotransferases in diabetic patients with undetectable non-alcoholic fatty liver disease by ultrasound. Diabetol Metab Syndr 2010; 2:65. [PMID: 21047423 PMCID: PMC2987914 DOI: 10.1186/1758-5996-2-65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 11/03/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite ongoing findings on the relationship between elevated levels of alanine and aspartate aminotransferases (ALT and AST) and metabolic syndrome (MetS), this association in diabetic patients without a known cause for liver enzymes elevation other than diabetes, per se, remains unclear. In this study, we aimed to assess the relationship between circulating liver enzymes and MetS in a relatively large sample of patients with diabetes. METHODS A total of 670 diabetic patients, without known causes of hepatocellular injury, were enrolled. Patients with ultrasonographic signs of fatty liver disease were not included. Fasting blood samples were obtained and biochemical characteristics were measured. MetS was defined according to the international diabetes federation criteria. RESULTS Serum ALT and AST were significantly higher in patients with MetS (p < 0.001). High waist circumference and low HDL-cholesterol were significantly associated with elevated ALT (OR = 2.56 and 2.0, respectively) and AST (OR = 2.23 and 2.21, respectively). ALT and AST were significantly associated with MetS (OR = 2.17 and 2.31, respectively). These associations remained significant after multiple adjustments for age, sex, BMI, diabetes duration, HbA1c and medications. There was a significant (p < 0.01) positive association between the number of the MetS features and the level of ALT or AST. CONCLUSION In diabetic patients without ultrasonographic evidence of fatty liver, elevated aminotransferases are independently associated with MetS. Despite negative ultrasound results in diabetic patients with MetS, the serum level of liver aminotransferases may be elevated and should be more thoroughly monitored.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arsia Jamali
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Khalilzadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imaging Medical Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Noshad
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Khalili
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Zandieh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Morteza
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Ma X, Holalkere NS, Kambadakone R A, Mino-Kenudson M, Hahn PF, Sahani DV. Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics 2009; 29:1253-77. [PMID: 19755595 DOI: 10.1148/rg.295085186] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fatty liver disease comprises a spectrum of conditions (simple hepatic steatosis, steatohepatitis with inflammatory changes, and end-stage liver disease with fibrosis and cirrhosis). Hepatic steatosis is often associated with diabetes and obesity and may be secondary to alcohol and drug use, toxins, viral infections, and metabolic diseases. Detection and quantification of liver fat have many clinical applications, and early recognition is crucial to institute appropriate management and prevent progression. Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but results are vulnerable to sampling error. Moreover, it can cause morbidity and complications and cannot be repeated often enough to monitor treatment response. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error. Selection of appropriate imaging methods demands understanding of their advantages and limitations and the suitable clinical setting. Ultrasonography is effective for detecting moderate or severe fatty infiltration but is limited by lack of interobserver reliability and intraobserver reproducibility. Computed tomography allows quantitative and qualitative evaluation and is generally highly accurate and reliable; however, the results may be confounded by hepatic parenchymal changes due to cirrhosis or depositional diseases. Magnetic resonance (MR) imaging with appropriate sequences (eg, chemical shift techniques) has similarly high sensitivity, and MR spectroscopy provides unique advantages for some applications. However, both are expensive and too complex to be used to monitor steatosis.
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Affiliation(s)
- Xiaozhou Ma
- Division of Abdominal Imaging and Intervention Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA
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Kim DY, Park SH, Lee SS, Kim HJ, Kim SY, Kim MY, Lee Y, Kim TK, Khalili K, Bae MH, Lee JY, Lee SG, Yu ES. Contrast-enhanced computed tomography for the diagnosis of fatty liver: prospective study with same-day biopsy used as the reference standard. Eur Radiol 2009; 20:359-66. [PMID: 19727755 DOI: 10.1007/s00330-009-1560-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/26/2009] [Accepted: 07/13/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE The study purpose was to prospectively determine the accuracy of contrast-enhanced CT in diagnosing fatty liver using same-day biopsy as the reference standard. MATERIALS AND METHODS One hundred seventy-nine potential living liver donors underwent unenhanced and portal-phase contrast-enhanced hepatic CT and subsequent liver biopsy on the same day. Attenuation difference between the liver and the spleen on unenhanced (( pre ) L-S) and contrast-enhanced (( post ) L-S) images and blood-subtracted hepatic attenuation on contrast-enhanced images (( post ) L-B), calculated by [L - 0.3 x (0.75 x P + 0.25 x A)]/0.7 where L, P and A represent the attenuation of the liver, main portal vein and abdominal aorta, respectively, were obtained. The accuracy of these indices in diagnosing fatty liver according to various threshold levels, 5%-30% histological steatosis in increments of 5%, was compared using ROC analysis. RESULTS The area under the ROC curve for ( pre ) L-S, ( post ) L-S and ( post ) L-B was 0.663-0.918, 0.712-0.847 and 0.821-0.923, respectively, depending on the threshold levels of hepatic steatosis. The accuracy of ( pre ) L-S and ( post ) L-S did not differ (P >or= 0.054), despite a trend towards a lower accuracy with ( post ) L-S. ( post ) L-B yielded higher accuracy than ( pre ) L-S at threshold levels of 5% and 10% (P <or= 0.002) and similar accuracy to ( pre ) L-S at the other threshold levels (P >or= 0.144). CONCLUSION Portal-phase contrast-enhanced CT has a similar, or even greater, accuracy than unenhanced CT in diagnosing fatty liver.
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Affiliation(s)
- Dae Yoon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Abstract
PURPOSE OF REVIEW Intrahepatic fat content is increasingly being recognized as an integral part of metabolic dysfunction. This article reviews available methods for the assessment of hepatic steatosis. RECENT FINDINGS Apart from liver biopsy, there are several noninvasive radiologic modalities for evaluating nonalcoholic fatty liver disease. Ultrasonography, computed tomography, and traditional MRI remain largely qualitative methods for detecting mild to severe degrees of steatosis rather than quantitative methods for measuring liver fat content, even though novel attempts to collect objective quantitative information have recently been developed. Still, their sensitivity at mild degrees of steatosis is poor. Undoubtedly, most methodological advances have occurred in the field of MRI and magnetic resonance spectroscopy, which currently enable the accurate quantification of intrahepatic fat even at normal or near normal levels. Xenon computed tomography was also recently shown to offer another objective tool for the quantitative assessment of steatosis, although more validation studies are required. SUMMARY Several modalities can be used for measuring intrahepatic fat and assessing steatosis; the choice will ultimately depend on the intended use and available resources.
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Affiliation(s)
- Elisa Fabbrini
- Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Schwenzer NF, Springer F, Schraml C, Stefan N, Machann J, Schick F. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 2009; 51:433-45. [PMID: 19604596 DOI: 10.1016/j.jhep.2009.05.023] [Citation(s) in RCA: 520] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic steatosis is the most prevalent liver disorder in the developed world. It is closely associated with features of metabolic syndrome, especially insulin resistance and obesity. The two most common conditions associated with fatty liver are alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Liver biopsy is considered the gold standard for the assessment of liver fat, but there is a need for less invasive diagnostic techniques. New imaging modalities are emerging, which could provide more detailed information about hepatic tissue or even replace biopsy. In the present review, available imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and proton magnetic resonance spectroscopy) are presented which are employed to detect or even quantify the fat content of the liver. The advantages and disadvantages of the above-mentioned imaging modalities are discussed. Although none of these techniques is able to differentiate between microvesicular and macrovesicular steatosis and to reveal all features visible using histology, the proposed diagnostic modalities offer a wide range of additional information such as anatomical and morphological information non-invasively. In particular, magnetic resonance imaging and proton magnetic resonance spectroscopy are able to quantify the hepatic fat content hence avoiding exposure to radiation. Except for proton magnetic resonance spectroscopy, all modalities offer additional information about regional fat distribution within the liver. MR elastography, which can estimate the amount of fibrosis, also appears promising in the differentiation between simple steatosis and steatohepatitis.
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Affiliation(s)
- Nina F Schwenzer
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, 72076 Tübingen, Germany
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Quels outils pour le diagnostic non invasif de la stéatose et de la fibrose chez les patients atteints de stéatopathie métabolique ? ACTA ACUST UNITED AC 2009; 33:405-12. [DOI: 10.1016/j.gcb.2009.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Mazhar SM, Shiehmorteza M, Sirlin CB. Noninvasive assessment of hepatic steatosis. Clin Gastroenterol Hepatol 2009; 7:135-40. [PMID: 19118644 PMCID: PMC6658187 DOI: 10.1016/j.cgh.2008.11.023] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/25/2008] [Accepted: 11/26/2008] [Indexed: 02/07/2023]
Abstract
Hepatic steatosis, the accumulation of lipids within hepatocytes, is a common condition. The prevalence of its most frequent manifestation, nonalcoholic fatty liver disease (NAFLD), has been estimated to be as high as 35% in some populations. Currently, liver biopsy is the gold standard for the diagnosis and assessment of severity of hepatic steatosis, staging of fibrosis, and is the only modality able to differentiate bland steatosis from steatohepatitis. However, its invasiveness, significant side effect profile, and susceptibility to sampling error ultimately make it a suboptimal tool. Accordingly, focus has been placed on noninvasive radiologic techniques for hepatic fat detection and quantification. The rationale, performance characteristics, and limitations of traditional noninvasive measures, including ultrasound, computed tomography, and magnetic resonance (MR) spectroscopy and imaging, are reviewed. A novel MR method, the spectrally modeled relaxation-invariant technique, overcomes the inherent weaknesses of conventional MR to diagnose and quantify hepatic steatosis over its entire range of severity. Noninvasive radiologic techniques, particularly MR, can be applied broadly, including in the diagnosis of NAFLD in asymptomatic patients with elevated serum aminotransferase levels, longitudinal monitoring of disease progression or response to treatment, population-based epidemiologic or observational studies, and drug discovery.
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Affiliation(s)
- Sameer M Mazhar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, San Diego, California, USA
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Roldan-Valadez E, Favila R, Martínez-López M, Uribe M, Méndez-Sánchez N. Imaging techniques for assessing hepatic fat content in nonalcoholic fatty liver disease. Ann Hepatol 2008. [PMID: 18753987 DOI: 10.1016/s1665-2681(19)31850-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD), an emerging clinical entity with worldwide recognition, is today the most common cause of abnormal liver function tests among adults in the United States. In Mexico City, its prevalence has been reported by our group to be around 14%, but its incidence is higher in the hispanic population in the United States (hispanic population 45%, white population 33%, black population 24%). The main issues in the diagnosis, follow-up, and management of NAFLD are our limited understanding of its pathophysiology and the difficulties involved in developing a noninvasive diagnostic method. Several imaging techniques can detect fatty infiltration of the liver, each with its own advantages and disadvantages. Ultrasound is still in the first option for diagnosis, but its accuracy depends on the operator and the patient's features. Computed tomography can detect hepatic fat content, but only at a threshold of 30%, and it involves ionizing radiation. Magnetic resonance (MR) spectroscopy is probably the most accurate and fastest method of detecting fat, but it is expensive and the necessary software is still not easily available in most MRI units. MR elastography, a new technique to detect liver stiffness, has not been demonstrated to detect NAFLD, and is still undergoing research in patients with hepatitis and cirrhosis. In conclusion, all these imaging tools are limited in their ability to detect coexisting inflammation and fibrosis. In this review, we discuss the radiological techniques currently used to detect hepatic fat content.
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Mehta SR, Thomas EL, Bell JD, Johnston DG, Taylor-Robinson SD. Non-invasive means of measuring hepatic fat content. World J Gastroenterol 2008; 14:3476-83. [PMID: 18567074 PMCID: PMC2716608 DOI: 10.3748/wjg.14.3476] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic steatosis affects 20% to 30% of the general adult population in the western world. Currently, the technique of choice for determining hepatic fat deposition and the stage of fibrosis is liver biopsy. However, it is an invasive procedure and its use is limited, particularly in children. It may also be subject to sampling error. Non-invasive techniques such as ultrasound, Computerized tomography (CT), magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRS) can detect hepatic steatosis, but currently cannot distinguish between simple steatosis and steatohepatitis, or stage the degree of fibrosis accurately. Ultrasound is widely used to detect hepatic steatosis, but its sensitivity is reduced in the morbidly obese and also in those with small amounts of fatty infiltration. It has been used to grade hepatic fat content, but this is subjective. CT can detect hepatic steatosis, but exposes subjects to ionizing radiation, thus limiting its use in longitudinal studies and in children. Recently, magnetic resonance (MR) techniques using chemical shift imaging have provided a quantitative assessment of the degree of hepatic fatty infiltration, which correlates well with liver biopsy results in the same patients. Similarly, in vivo1H MRS is a fast, safe, non-invasive method for the quantification of intrahepatocellular lipid (IHCL) levels. Both techniques will be useful tools in future longitudinal clinical studies, either in examining the natural history of conditions causing hepatic steatosis (e.g. non-alcoholic fatty liver disease), or in testing new treatments for these conditions.
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Abstract
OBJECTIVE The inflammatory subtype of nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, is becoming one of the most important causes of chronic liver disease. In this article, we discuss the epidemiology, pathogenesis, and clinical and radiologic diagnosis of the subtypes of nonalcoholic fatty liver disease. CONCLUSION We discuss the current and evolving imaging tests in the evaluation of hepatic fatty content, inflammation, and fibrosis.
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Kodama Y, Ng CS, Wu TT, Ayers GD, Curley SA, Abdalla EK, Vauthey JN, Charnsangavej C. Comparison of CT methods for determining the fat content of the liver. AJR Am J Roentgenol 2007; 188:1307-12. [PMID: 17449775 DOI: 10.2214/ajr.06.0992] [Citation(s) in RCA: 354] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to assess which of a number of methods of measuring attenuation on CT scans is best for prediction of hepatic fat content. MATERIALS AND METHODS This retrospective study was approved by our institutional review board. Consecutively registered patients who underwent liver resection for metastatic disease formed the study group. Attenuation measurements were obtained from 12 regions of interest in the liver and three in the spleen on both unenhanced and portal phase contrast-enhanced preoperative hepatic CT images. Hepatic attenuation measurements were analyzed both with and without normalization with the spleen. Normalization included both differences and ratios between hepatic and splenic attenuation values. Pathologic fat content was graded semiquantitatively as a percentage of the nonneoplastic liver parenchyma of the resected specimen. Average attenuation values of the liver were compared with pathologic fat content, as were the differences and ratios between hepatic and splenic attenuation values. Linear regression analysis was conducted on a log-log scale. RESULTS Data on 88 patients were analyzed. On unenhanced and contrast-enhanced CT images, all associations between pathologic fat content and attenuation measurements were significant (p < 0.0001). All series of R2 values for unenhanced CT scans were much higher than those for contrast-enhanced CT scans. The R2 values of liver-only measurement were higher than those of hepatic values normalized with splenic values on both unenhanced (0.646-0.649 > 0.523, 0.565) and contrast-enhanced (0.516 > 0.242, 0.344) CT. CONCLUSION Measurement of attenuation of liver only on unenhanced CT scans is best for prediction of pathologic fat content.
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Affiliation(s)
- Yoshihisa Kodama
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 368, Houston TX 77030, USA
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Karcaaltincaba M, Akhan O. Imaging of hepatic steatosis and fatty sparing. Eur J Radiol 2006; 61:33-43. [PMID: 17118603 DOI: 10.1016/j.ejrad.2006.11.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 11/02/2006] [Indexed: 02/06/2023]
Abstract
Radiology has gained importance in the non-invasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced CT with or without dual kVp measurement and MRI with in and out of phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate non-alcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop shop evaluation of potential liver donors has become possible by CT and MRI integrating vascular, parenchymal, volume and steatosis evaluation. Moreover hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal and perivenular), hypersteatosis and sparing (geographic, nodular and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing, quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing.
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