Contrast-enhanced computed tomography for the diagnosis of fatty liver: prospective study with same-day biopsy used as the reference standard

Kim, Dae Yoon; Park, Seong Ho; Lee, Seung Soo; Kim, Hye Jin; Kim, So Yeon; Kim, Minyoung; Lee, Yedaun; Kim, Tae Kyoung; Khalili, Korosh; Bae, Moo-Ho; Lee, Joo Yeon; Lee, Sung‐Gyu; Yu, Eun Sil

doi:10.1007/s00330-009-1560-x

Cited by 57 publications

(61 citation statements)

References 29 publications

(56 reference statements)

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“…Park et al liver reported in another study ( 20 ) and is therefore probably negligible. In contrast, we found hepatic iron deposition to be a potential confounding factor in the generalization of the reference range of CT L 2 S values and the threshold CT L 2 S for diagnosing hepatic steatosis.…”

Section: Gastrointestinal Imaging: Ct Attenuation Criteria For Diagnomentioning

confidence: 85%

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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Section: Gastrointestinal Imaging: Ct Attenuation Criteria For Diagnomentioning

confidence: 85%

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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“…In 2010, other authors such as Kim et al (17) , in a prospective study whose goldstandard was liver biopsy, that the non-contrast-enhanced phase could be suppressed in the evaluation of hepatic steatosis, being replaced by the portal phase, with high sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

et al. 2013

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Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis. Keywords: Computed tomography; Ionizing radiation; Abdomen; Contrast media.Objetivo: Avaliar a necessidade da fase sem contraste nos exames de tomografia computadorizada de abdome. Materiais e Métodos: Foi realizado estudo retrospectivo, transversal e observacional, no qual foram avaliados 244 exames consecutivos de tomografia computadorizada de abdome realizados sem e com a injeção do meio de contraste. Procurou-se estabelecer, mediante análise das fases com o uso do meio de contraste (primeira análise), e posteriormente com o acréscimo da avaliação da fase sem meio de contraste (segunda análise), o diagnóstico principal e os secundá-rios em função da indicação clínica do exame (estadiamento tumoral, abdome agudo, pesquisa de coleção abdominal e hepatocarcinoma, entre outros). Foram medidas as mudanças nos diagnósticos principais e secundários, decorrentes do acréscimo da fase sem meio de contraste. Resultados: Dos 244 casos avaliados, apenas um (0,4%; p > 0,999; não significante) teve o seu diagnóstico modificado após a leitura da fase sem meio de contraste. Com relação aos diagnósticos secundários, 35 exames (14%) foram modificados após a segunda análise, sendo: nefrolitíase (10%), esteatose (3%), nódulo de adrenal (0,7%) e colelitíase (0,3%). Conclusão: Para as indicações clínicas de estadiamento tumoral, abdome agudo, pesquisa de coleção abdominal e carcinoma hepatocelular, a supressão da fase sem meio de contraste não apresentou impacto diagnóstico expressivo. Unitermos: Tomografia computadorizada; Radiação ionizante; Abdome; Meio de contraste.

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“…The diagnosis of HS with contrast-enhanced CT was obtained by means of the method proposed by Kim et al (9) , utilizing the formula [L -0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L corresponds to hepatic attenuation, P corresponds to portal vein attenuation, and A corresponds to abdominal aorta attenuation. The measurements were performed in the portal venous contrast phase, i.e., between 60 and 80 seconds after the initiation of the intravenous contrast medium injection.…”

Section: Methodsmentioning

confidence: 99%

“…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) . The most recent of those studies demonstrated that, with the isolated utilization of the portal phase, it is possible to obtain accuracy similar to that obtained with the criteria adopted at non-contrastenhanced CT in the diagnosis and quantification of HS (9) .…”

Section: Introductionmentioning

confidence: 99%

“…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) . The most recent of those studies demonstrated that, with the isolated utilization of the portal phase, it is possible to obtain accuracy similar to that obtained with the criteria adopted at non-contrastenhanced CT in the diagnosis and quantification of HS (9) . The authors proposed a mathematical equation which takes into consideration the average density of the portal vein and the aorta based on measurements obtained at three different sites and the average density of the liver obtained from eight measurements (two for each one of the four segments of the right lobe).…”

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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Contrast-enhanced computed tomography for the diagnosis of fatty liver: prospective study with same-day biopsy used as the reference standard

Abstract: Portal-phase contrast-enhanced CT has a similar, or even greater, accuracy than unenhanced CT in diagnosing fatty liver.

Cited by 57 publications

References 29 publications

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

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

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

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