Focal fatty change of the liver adjacent to the falciform ligament: CT and sonographic findings in five surgically confirmed cases

Abstract

Five cases of surgically confirmed focal fatty infiltration of the liver were detected by CT and sonography.In all five cases, the abnormality was located at the anterolateral edge of the medial segment of the liver. It was seen as a small area of low attenuation . However, when it has the appearance of a small nodule, it can be confused with various focal hepatic diseases [7-9]. We describe five surgically confirmed cases of this abnormality that were detected adjacent to the falciform ligament by CT and sonography. Materials and MethodsBetween June 1985 and December 1986, we encountered five patients in whom focal fatty change of the liver adjacent to the falciform ligament was discovered incidentally on CT and sonographic examinations performed to detect cholelithiasis or liver metastasis. CT scans and sonograms were analyzed, and the patients' clinical records were reviewed. All of the patients were women (average age, 64 years; range, 47-57 years) and had cholelithiasis (three cases) or sigmoid colon cancer (one case) or both (one case). Their liver function tests were normal except for one patient whose alkaline phosphatase level was slightly elevated. One had diabetes. None had a history of alcoholism. CT studies were performed with a Somatom DR2 scanner with a section thickness of 8 mm (three cases) or with a GE CT/ T9800 scanner with a section thickness of 1 0 mm (two cases). All CT scans were obtained with and without IV contrast material. Sonography was performed in all cases with a 3.5-or 5-MHz transducer of Aloka SSD-270 or Toshiba SAL 77A. Angiography was done in two cases. Dynamic CT was carried out during injection of contrast medium (65% meglumine amidotrizoate) in one case. The medium was injected via a catheter in the superior mesenteric artery at an estimated rate of 1 mI/sec, with a total dose of 10 ml [1 0 . In all patients, the lesion was resected during surgery performed for unrelated reasons, and the diagnosis of focal fatty infiltration of the liver was established histologically. ResultsCT scans showed a small area of low attenuation in the anterolateral part of the medial segment of the liver adjacent to the falciform ligament (Fig. 1). In all but one case, the lesions were shown on both plain and enhanced CT scans. In this case,

Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT.

“…These regions of interest each encompassed atleastI cm2(range, Iâ€"I .5cm2)andwereplacedin approximately the samelocationon everyslice, avoidingvesselsand artifacts.If focal regionsof de creased attenuation(suggestinggeographicfatty in filtration) were apparent within the liver on the unenhancedimages, a region-of-interestcursor was placed over these sites, excluding small regions of Contrast-enhancedstudies were then acquiredof each patient using a helical CT scanner (HiSpeed Qualitativeassessment of the presence of fatty liverwasperformed byfourobservers whowereun awareof the findingson the unenhanced images. Observers1 and2 wereexperienced, full-time ab dominal CT radiologists, observer 3 was a gas trointestinal radiologist interpreting abdominal CT on a regularpart-timebasis,and observer4 was a ra diologist who only occasionallyinterpretsabdomi nal CT.These observersassessedcontrast-enhanced sideredto bepresent if smallregionsof fat deposi tion were limited to areas in which fatty infiltration had been previously documented to frequently oc cur: adjacentto the fissurefor the ligamentumteres and withinthe posterioraspectof the medialleft he patic lobe [6,7]. Individualand pooled sensitivity and specificityvalueswere determinedfor the three qualitative parameters evaluated.…”

Invisible fat on CT: making it visible by MRI

“…Among the most confusing liver lesions on CT are the focal fat sparing and deposition in the liver parenchyma. Although the diagnosis of these abnormalities might be easier in typical locations such as near the gallbladder fossa, medial segment of the left hepatic lobe, or close to the falciform ligament (12,13), in atypical locations and in case of unconventional morphology, the diagnosis can be difficult. Focal steatotic changes are more and more commonly seen in oncologic patients due to complex and prolonged chemotherapy (14).…”

Radiologic manifestation of hepatic pseudolesions and pseudotumors in the third inflow area

“…In the focal form, various types of fatty infiltration have been described, and the anteromedial portion of segment IV, adjacent to the falciform ligament, is one of the most commonly involved locations [31].…”