Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements

Johnston, R. J.; Stamm, Elizabeth R.; Lewin, John M.; Hendrick, R. Edward; Archer, Philip G.

doi:10.1007/s002619900370

Cited by 91 publications

(65 citation statements)

References 25 publications

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“…The degree of decrease in attenuation on unenhanced CT is the most decisive of the degree of liver fat content [31] . Due to the attenuation characteristics that are based on various factors regarding to the contrast material and scan timing, unenhanced CT is more commonly used than enhanced CT [3,15,32] . Unenhanced CT can be especially used for evaluating the fatty liver in a transplant donor.…”

Section: Ctmentioning

confidence: 99%

Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease

Koplay

Sivri

Erdoğan

et al. 2015

WJH

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Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease and is a major public health problem worldwide. It is a spectrum that includes simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Recently, NAFLD prevalence in children and adolescents has increased too. The increasing prevalence has resulted in NASH-related chronic liver disease. Therefore, early diagnosis and treatment is quite important. Although liver biopsy is still the gold standard for diagnosis and staging of NAFLD, particularly for the diagnosis of NASH, imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging with chemical shift imaging and especially magnetic resonance spectroscopy and elastography have been increasingly approved as noninvasive alternative methods. The aim of this review is to analyze the diagnostic accuracy and limitations of the imaging methods and recent developments in the diagnosis of NAFLD.

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Section: Ctmentioning

confidence: 99%

Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease

Koplay

Sivri

Erdoğan

et al. 2015

WJH

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“…This is as a result of natural variability in the underlying hepatic structure of different subjects affecting attenuation readings, e.g. iron, iodine [33], copper, and glycogen content [34], fibrosis or edema [34] may affect attenuation. Therefore, for subjects with little or no hepatic fat content, any variability in attenuation may result in calculation of a negative value using the slope and intercept regression model.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Quantification of Hepatic Steatosis: Relationship Between Obesity Status and Liver Fat Content

McLeay¹,

Morrish²,

Ponnuswamy³

et al. 2014

TOOBESJ

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Abstract:The aim of this study was to assess and compare fat content within the liver for normal (body mass index (BMI) < 25 kg/m 2 ), overweight (25-30 kg/m 2 ) and obese ( 30 kg/m 2 ) subjects using a noninvasive, non-contrast computed tomography (CT) quantification method. Adult subjects aged 18-60 yrs scheduled to undergo CT examination of the abdominal region were recruited for this study, stratified across BMI categories. Liver volume, fat content, and lean liver volume were determined using CT methods. A total of 100 subjects were recruited, including 30 normal weight, 31 overweight, and 39 obese. Total liver volume increased with BMI, with mean values of 1138 ± 277, 1374 ± 331, and 1766 ± 389 cm 3 for the normal, overweight, and obese, respectively (P < 0.001), which was due to an increase in both liver fat content and lean liver volume with BMI. Some obese subjects had no or minimal hepatic fat content. The prevalence of mild fatty liver in this study of 100 subjects was overestimated for all BMI categories using a range of qualitative diagnostic measures, with predicted prevalence of fatty liver in obese subjects ranging from 76.9% for liver-to-spleen ratio 1.1 to 89.7% for liver attenuation index (liver HU -spleen HU) 40, compared to 66.7% by quantification of fat content. Results show that total liver volume increases with BMI, however, not all obese subjects display fatty infiltration of the liver. CT quantification of liver fat content may be suitable for accurate diagnosis of hepatic steatosis in clinical practice and assessment of donor livers for transplantation.

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“…Several studies have been undertaken by Brazilian authors approaching the importance of imaging methods in the evaluation of liver diseases (24)(25)(26)(27)(28) , with CT diagnosis of HS being traditionally made according the criteria applied to the non-contrast-enhanced phase (10,11,16) . However, in a scenario of increased preoccupation with the harmful effects of ionizing radiation, and considering the opportunity to obtain the diagnosis of HS by means of the portal contrast-enhanced phase and the fact that such phase is the most useful in most abdominal CT indications (9,14,15) , the possibility of confirming the value of contrast-enhanced CT in the screening for HS becomes particularly interesting.…”

Section: Discussionmentioning

confidence: 99%

“…Such a strategy, in spite of having demonstrated good results, is time consuming for the investigator, making the method somewhat tiresome and certainly more complex than the simple measurements obtained with the non-contrast-enhanced phase. Additionally, the several variables involved in the process, such as concentration, contrast medium injection velocity and acquisition time may influence the results (16) , lead to the necessity of validating the previous results and prove the usefulness of a simplified method for HS diagnosis by means of contrast-enhanced CT.…”

Section: Introductionmentioning

confidence: 99%

“…The contrast-enhanced portal phase performed between 60 and 80 seconds after intravenous contrast injection is isolatedly considered as being the most useful phase in the greatest majority of indications for upper abdomen CT, provided the reliability and diagnostic accuracy of the method is assured , leading to a tendency to abolish the non-contrast-enhanced phase. On the other hand, according to several authors, the CT criteria for diagnosis of HS are dependent on such phase (10,11,16) . Such a fact has stimulated the undertaking of studies which attempted to establish the value of the portal phase isolatedly in the diagnosis of hepatic steatosis (9,10,17) .…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

et al. 2013

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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. Keywords: Fatty liver; Steatosis; Liver disease; Tomography; Multidetector computed tomography; Contrast media.Objetivo: Comparar a capacidade diagnóstica para esteatose hepática utilizando-se a fase portal com método simplificado de cálculo com a fase sem contraste na tomografia computadorizada de abdome. Materiais e Métodos: Foi realizado estudo retrospectivo em 150 pacientes submetidos a tomografia computadorizada de abdome sem e com contraste intravenoso, 100 deles com esteatose hepática e 50 controles. Para diagnóstico de esteatose hepática na fase portal considerou-se um resultado < 104 UH aplicando-se a fórmula [L -0,3 × (0,75 × P + 0,25 × A)] / 0,7, onde L, P e A representam a atenuação hepática, da veia porta e da aorta, respectivamente. Foram calculados sensibilidade, especificidade, valores preditivos positivos e negativos, utilizando-se a tomografia computadorizada sem contraste intravenoso como padrão de referência. Resultados: O método simplificado de cálculo para o diagnóstico de esteatose hepática na fase portal mostrou sensibilidade de 100%, especificidade de 36%, valor preditivo negativo de 100% e valor preditivo positivo de 75,8%. A taxa de falso-positivos foi 64%. Não foram encontrados falso-negativos. Conclusão: A utilização da fase portal apresenta elevada sensibilidade para o diagnóstico de esteatose hepática, quando comparada à fase sem contraste da tomografia computadorizada de abdome. Por outro lado, o método apresenta baixa especificidade. Unitermos: Fígado gorduroso; Esteatose hepática; Hepatopatias; Tomografia; Tomografia computadorizada multidetectores; Meios de contrast...

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Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements

Abstract: Contrast injection rate and timing of measurements significantly influence the optimal L-S threshold for diagnosing fatty liver. This limits the clinical usefulness of such measurements.

Cited by 91 publications

References 25 publications

Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease

Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease

Noninvasive Quantification of Hepatic Steatosis: Relationship Between Obesity Status and Liver Fat Content

Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

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