Ultrasound diagnosis of fatty liver in patients with chronic liver disease: a retrospective observational study

OBJECTIVES

Hepatic ultrasound (US) is readily available and physicians usually trust the results of an US report suggesting fatty liver, but there are conflicting reports on its accuracy, especially in patients with chronic liver disease (CLD). Therefore, we retrospectively examined liver biopsies in patients with CLD and compared the histologic results to the hepatic US findings.

METHODS

Liver biopsies were graded for fat (grades 0 to 3), inflammation (grades 0 to 4), and fibrosis (stages 0 to 4) in 131 patients with CLD (89% had chronic hepatitis C). Hepatic US interpretations were grouped into 3 categories-"normal," "fatty liver," and "nonspecific." A secondary analysis was performed using 3 sonographic categories based on the echogenicity: normal, "increased echogenicity," and "heterogenous." The US results were then compared with the liver biopsy results.

RESULTS

A normal US report was associated with many false negatives, as 25% of these patients had fat (grades 1 to 3) on biopsy; furthermore, 46% had "significant fibrosis" (stages 2 to 4) or "significant inflammation" (grades 2 to 4). A "fatty liver" interpretation correctly identified fat on biopsy in 36.4% and "significant fat" (grades 2 to 3) in 11.4%, but 66% had significant fibrosis or significant inflammation. An US with increased echogenicity correctly identified fat in 43.5% and significant fat in 19.4%, but 69.4% had significant fibrosis or significant inflammation. The sensitivity of an US ranged from 11.4% to 88.2% and the specificity ranged from 40.4% to 86.2%, depending on the degree of steatosis on biopsy and the sonographic interpretation being considered.

CONCLUSIONS

US is inaccurate for diagnosing hepatic steatosis in patients with CLD. Echogenic abnormalities are more likely to be the result of fibrosis or inflammation in this setting.

Recognition of the Ovaries and Ovarian Origin of Pelvic Masses with CT

Knowledge of the morphologic features and ligamentous attachments of the ovaries, the relationship of the ovary to the ureter, and the course of the ovarian vein and artery is necessary for confident recognition of the ovaries and differentiation between ovarian and nonovarian masses with computed tomography (CT). The suspensory ligament attaches the ovary to the pelvic sidewall and transmits the ovarian vein and artery. This ligament may be seen at CT as a linear or fan-shaped soft-tissue band leading to the ovary. The utero-ovarian ligament is occasionally visualized with CT as a soft-tissue band between the uterus and ovary. The ovaries are usually located anterior or anteromedial to the pelvic ureters, whereas iliac lymph nodes are lateral or posterolateral to the ureters. Therefore, an ovarian mass displaces the ureter posteriorly or posterolaterally, whereas a large lymph node mass displaces the ureter medially or anteromedially. An ovarian mass may be draped by ovarian parenchyma, thus revealing the origin of the mass. Tracking the ovarian vein from near the level of the renal vessels caudally to the pelvis leads to the suspensory ligament region and is often helpful in identifying the ovary and differentiating ovarian and nonovarian masses.

CT diagnosis of perihepatic endometriosis complicated by malignant transformation

Endometriosis is a condition in which endometrial tissue becomes implanted on extrauterine sites, most commonly within the pelvis. Malignant transformation of endometriotic foci is rare, but has been frequently reported. We describe a patient with a CT scan demonstrating pathologically proven perihepatic endometriosis, including malignant transformation. Endometrioses should be considered in the differential diagnosis of perihepatic masses.

Periprosthetic mycobacterial infection. CT and mammographic findings

Organisms of the Mycobacterium fortuitum complex are an uncommon but important cause of periprosthetic infection following augmentation mammoplasty or other breast surgery. This etiological agent must be considered in the particular case of periprosthetic infection, because special handling of the fluid is crucial to enhance recovery of the organism. We describe the computed tomography (CT) and mammographic findings in such an abscess with respect to the clinical context and subsequent management. To our knowledge, CT findings associated with any periprosthetic breast infection have not been described.

Computed tomography of pulmonary hydatid disease

The CT findings in 20 patients with pulmonary hydatid disease were reviewed. Sixty-four intrapulmonary cysts were imaged, 22% of which were ruptured or complicated. Simple hydatid cysts and water-density lung cysts of other etiology may have a similar CT appearance; however, the demonstration of the cystic nature of a lung lesion in endemic areas makes hydatid disease the primary consideration. Pathognomonic features in ruptured or complicated hydatid cysts that can be visualized better by CT than by conventional radiography include detached or collapsed endocyst membrane(s), collapsed daughter cyst membranes, and intact daughter cysts.

Computed tomography of perirenal and pararenal inflammatory disease complicating renal calculi

In the presence of unsuspected extensive perirenal and pararenal disease, renal calculus surgery may be associated with extensive morbidity and mortality. To plan surgery properly, computed tomography (CT) often can be essential preoperatively. Three cases are presented where CT readily demonstrated the degree of extrarenal extension. No other imaging modality can demonstrate this involvement as accurately and as easily.

Computed tomography of endometriosis

Six examples of pelvic masses due to endometriosis were detected by computed tomography (CT) in a group of women aged 30-43. Lower abdominal or pelvic pain was the chief complaint in four cases. The ileum and rectosigmoid were routinely opacified with contrast material prior to examination. Endometriosis exhibited a variety of findings including a constricting rectosigmoid mass, a lesion of the pelvic side wall, bowel wall implants, and posthysterectomy pelvic masses. There was no standard CT density; the lesion near the pelvic side wall appeared solid, one cul-de-sac mass appeared solid, and a second had a mixed cystic and solid appearance. Discrete adnexal endometriosis appeared as thick-walled cystic masses (two cases) or as a simple cyst (one case). Bowel wall involvement and the pelvic side wall lesion were not successfully identified by ultrasound. It is concluded that CT can play a role in the diagnosis of endometriosis.

Computed tomography of calcified liver masses

Our retrospective study of 230 computed tomographic (CT) studies of hepatic masses yielded 28 cases (12.2%) which contained calcification. Calcific deposits were noted in 9 of 59 patients (15.3%) with hepatocellular carcinoma (HCC), 15 of 82 patients (18.3%) with liver metastases from colorectal carcinoma (MCRC), 2 of 71 patients (2.8%) with noncolonic liver metastases, and 2 of 18 patients (11%) with a benign liver mass. The patterns of calcification in HCC and MCRC were highly variable and exhibited some overlap. Although the CT demonstration of calcification in HCC and MCRC is not uncommon, particularly in patients who have undergone radiotherapy or chemotherapy, we could identify no specific diagnostic pattern.

Renal lithiasis in Lebanon: I--the chemical types of urinary calculi

The results of chemical analyses of 429 urinary calculi are presented and classified according to chemical composition. Some of the general features of the different chemical types of the stones are discussed. Although the general distribution of the chemical types of stones in Lebanon is essentially similar to that reported from other countries, the two striking features of this series are: (1) a relatively lower incidence of infection stones (i.e. stones containing magnesium ammonium phosphate) and (2) a relatively higher incidence of stones containing a mixture of uric acid and calcium oxalate and/or calcium phosphate.