Macrovesicular Hepatic Steatosis in Living Related Liver Donors: Correlation between CT and Histologic Findings

Limanond, Piyaporn; Raman, Steven S.; Lassman, Charles; Sayre, James; Ghobrial, Rafik M.; Busuttil, Ronald W.; Saab, Sammy; Lu, David

doi:10.1148/radiol.2301021176

Cited by 330 publications

(281 citation statements)

References 20 publications

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“…With splenic attenuation acting as a control or reference value, the liver attenuation index (LAI), defined as the difference between mean hepatic attenuation and mean splenic attenuation, was used as an indicator of the degree of hepatic steatosis. Fatty liver disease was defined as a LAI below 5 HU on the unenhanced hepatic CT image at screening (21) and as an LAI below 218.5 HU on the contrastenhanced CT image (22). LAI in all subjects who underwent contrast-enhanced CT (n = 6) was evaluated between 80 and 120 s after injection of a contrast bolus.…”

Section: Ct Imagingmentioning

confidence: 99%

Improvement of Nonalcoholic Fatty Liver Disease With Carnitine-Orotate Complex in Type 2 Diabetes (CORONA): A Randomized Controlled Trial

et al. 2015

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OBJECTIVEWe aimed to evaluate the effects of carnitine-orotate complex in patients with nonalcoholic fatty liver disease (NAFLD) and diabetes. RESEARCH DESIGN AND METHODSEight hospitals in Korea participated in this randomized, controlled, double-blind trial of patients with diabetes and NAFLD. Seventy-eight patients were randomly assigned in a 1:1 ratio to receive carnitine-orotate complex (824 mg, three times daily) or matching placebo. The primary study outcome was decline in alanine aminotransferase (ALT) to the normal range. Secondary study outcomes were change in ALT, radiological hepatic steatosis, parameters for anthropometry, liver function, lipid profiles, and glycemic control. Hepatic steatosis was assessed using Hounsfield units on noncontrast computed tomography (CT) imaging with hepatic attenuation. RESULTSAfter 12 weeks of treatment, compared with placebo group, carnitine-orotate complex-treated participants had a significantly higher rate of normalization of serum ALT level (17.9% vs. 89.7%, P < 0.001). On hepatic CT analysis, participants treated with carnitine-orotate complex showed an increased liver attenuation index (0.74 6 8.05 vs. 6.21 6 8.96, P < 0.008). A significant decrease in HbA 1c was observed in the carnitine-orotate complex group (20.33 6 0.82% [23.6 6 9.0 mmol/mol], P = 0.007), but no significant change was seen in the placebo group. CONCLUSIONSTreatment with carnitine-orotate complex improves serum ALT and may improve hepatic steatosis as assessed by CT in patients with diabetes and NAFLD. Further studies using more advanced magnetic resonance imaging and liver histology as an end point are needed to assess its efficacy in NAFLD.Ectopic fat accumulation in a visceral organ is associated with insulin resistance (1). As an example of such ectopic fat accumulation, nonalcoholic fatty liver disease (NAFLD) is now recognized as the hepatic component of metabolic syndrome and is even reportedly associated with insulin resistance independent of obesity and other metabolic components. Therefore, NAFLD can be a major determinant of insulin

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Section: Ct Imagingmentioning

confidence: 99%

Improvement of Nonalcoholic Fatty Liver Disease With Carnitine-Orotate Complex in Type 2 Diabetes (CORONA): A Randomized Controlled Trial

et al. 2015

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“…Thirdly, the diagnosis of FL by CT was not confirmed by liver biopsies. However, a significant correlation has been demonstrated between the liver attenuation images on CT and the histological grade of steatosis (40). Fourthly, we did not measure insulin resistance by more sophisticated approaches such as the euglycemic clamp; however, the HOMA index has proven to be a reliable measure of insulin sensitivity in non-diabetics (41).…”

Section: Limitationsmentioning

confidence: 99%

Fatty liver largely explains associations of subclinical hypothyroidism with insulin resistance, metabolic syndrome, and subclinical coronary atherosclerosis

Posadas‐Romero

Jorge‐Galarza

Posadas-Sánchez

et al. 2014

European Journal of Endocrinology

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Background: The association of subclinical hypothyroidism (SCH) with insulin resistance, metabolic syndrome (MS), and coronary atherosclerosis is uncertain. Objective: To investigate the role of increased intrahepatic fat in the association of SCH with insulin resistance, MS, and coronary atherosclerosis. Design, patients, and methods: We conducted a cross-sectional study in a sample of 753 subjects (46% males) aged 35-70 years with no history of diabetes, renal, hepatic, thyroid, or coronary heart disease, and were participants of the Genetics of Atherosclerotic Disease study. SCH was defined as a high serum TSH level with normal free thyroxine concentration. Fatty liver (FL), coronary artery calcification (CAC), and abdominal visceral adipose tissue were assessed by computed tomography. Cross-sectional associations of SCH with and without FL, with MS, insulin resistance, and subclinical atherosclerosis defined as a CAC score O0, were examined in logistic regression models. Results: SCH was observed in 17.7% of the population studied. The prevalence of FL was similar in both euthyroid and SCH subjects (31.8 vs 27.8%, PZ0.371). SCH plus FL subjects were heavier and had more metabolic abnormalities compared with SCH plus normal liver subjects. In multivariate-adjusted logistic regression analyses, SCH plus FL was associated with MS (odds ratio (OR): 2.73, 95% CI: 1.26-5.92), insulin resistance (OR: 4.91, 95% CI: 1.63-14.75), and CAC score O0 (OR: 3.05, 95% CI: 1.20-7.76). SCH without FL showed no associations. Conclusion: SCH with FL is associated with increased odds of MS, insulin resistance, and CAC, independent of potential confounders.

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“…However, the absence of hepatic steatosis was not histopathologically confi rmed in these studies. Although there have been several histologically correlated studies of the CT criteria used to diagnose hepatic steatosis (10)(11)(12), the results of these investigations have been specifi c for the diagnosis of moderate to severe macrovesicular hepatic steatosis during hepatic donor evaluation and thus are not applicable to various other clinical settings.…”

Section: Study Subjectsmentioning

confidence: 99%

Biopsy-proven Nonsteatotic Liver in Adults: Estimation of Reference Range for Difference in Attenuation between the Liver and the Spleen at Nonenhanced CT

et al. 2011

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Purpose:To establish the reference range for hepatic attenuation minus splenic attenuation difference (CT L 2 S ) values on nonenhanced computed tomographic (CT) images obtained in adults with a biopsy-proved nonsteatotic liver and determine the CT L 2 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 2 S was measured in 315 liver donor candidates (207 men, 108 women; mean age, 31.5 years 6 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 2 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 2 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 2 S values of 1-18 HU. With a CT L 2 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 signifi cant but negligible effect on CT L 2 S (0.076-HU increase per year of age, P = .009), subject sex and scanner type had no effects on CT L 2 S , and hepatic iron deposition signifi cantly increased the CT L 2 S (1.434-HU increase per increase in iron deposition grade, P = .011). Conclusion:The histologically proved reference range of CT L 2 S values for nonsteatotic livers was 1-18 HU. A CT L 2 S of less than 1 HU could be used as a conservative criterion for diagnosing hepatic steatosis with nonenhanced CT more consistently.q RSNA, 2011

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Macrovesicular Hepatic Steatosis in Living Related Liver Donors: Correlation between CT and Histologic Findings

Cited by 330 publications

References 20 publications

Improvement of Nonalcoholic Fatty Liver Disease With Carnitine-Orotate Complex in Type 2 Diabetes (CORONA): A Randomized Controlled Trial

Improvement of Nonalcoholic Fatty Liver Disease With Carnitine-Orotate Complex in Type 2 Diabetes (CORONA): A Randomized Controlled Trial

Fatty liver largely explains associations of subclinical hypothyroidism with insulin resistance, metabolic syndrome, and subclinical coronary atherosclerosis

Biopsy-proven Nonsteatotic Liver in Adults: Estimation of Reference Range for Difference in Attenuation between the Liver and the Spleen at Nonenhanced CT

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