Dual-energy CT in the diagnosis and quantification of fatty liver: limited clinical value in comparison to ultrasound scan and single-energy CT, with special reference to iron overload

Mendler, Michel; Bouillet, Philippe; Sidaner, Anne Le; Lavoine, E; Labrousse, François; Sautereau, Denis; Pillegand, B

doi:10.1016/s0168-8278(98)80228-6

Cited by 136 publications

(91 citation statements)

References 41 publications

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“…Previous studies in which ultrasound findings were compared to histologic results showed that the overall sensitivity and specificity of ultrasound examination for diagnosis of fatty liver were approximately 80-95% and 90-95%, respectively. [46][47][48][49][50][51] Moreover, due to sampling errors, liver biopsies are reported as normal in subjects with focal fatty infiltration of the liver (approximately 5-10%). 52 Besides, due to ethical reason, liver biopsy cannot be performed in these relatively healthy individuals without overt liver abnormality.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric fat thickness as an independent determinant of fatty liver

Liu

Chan

et al. 2006

Int J Obes

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Objective: Mesenteric fat is drained by the portal circulation and has been suggested to be a key component in obesity-related health risk, notably the metabolic syndrome. There are increasing epidemiological and experimental data showing that fatty liver is another component of this multifaceted syndrome. Given their intimate anatomical and physiological relationships, we hypothesized that mesenteric fat thickness may be independently associated with the risk of fatty liver. To test this hypothesis, we examined the predictive role of various fat deposits including mesenteric fat thickness, and various metabolic variables on the risk of fatty liver. Subjects and methods: A total of 291 Chinese subjects (134 men and 157 women with a mean BMI of 23.7 kg/m 2 , range: 16.5-33.4 kg/m 2 ) underwent ultrasound examination for measurement of mesenteric, subcutaneous and preperitoneal fat thickness, and for diagnosis of fatty liver. Body mass index, waist circumference, and waist-hip ratio were recorded. Blood pressure was measured. Fasting plasma glucose, insulin resistance, high-density lipoprotein cholesterol (HDL-C), triglycerides, low-density lipoprotein cholesterol (LDL-C), liver enzymes were determined by common methods. Results: The subjects with fatty liver had greater abdominal fat thickness and higher anthropometric indexes than those without fatty liver. The subjects with fatty liver also showed higher blood pressure, worse lipid and glycaemic profile compared with those without fatty liver. Using multiple logistic regression analysis, mesenteric fat thickness was a risk factor of fatty liver, independent of body mass index, age, sex, insulin resistance, fasting plasma glucose, lipid and blood pressure. The odds ratio was 1.5 (95% confidence interval: 1.27-1.77) for every 1 mm increase in the mesenteric fat thickness. Measurement of preperitoneal and subcutaneous fat deposits did not show significant associations with fatty liver. Conclusion: Mesenteric fat thickness measured on ultrasound is an independent determinant of fatty liver.

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Section: Discussionmentioning

confidence: 99%

Mesenteric fat thickness as an independent determinant of fatty liver

Liu

Chan

et al. 2006

Int J Obes

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“…The prevalence of hepatic steatosis in moderately obese non-diabetic patients (such as our BMI-matched controls) has been shown to be approximately 29%. 47 Given the high reported sensitivity and specificity of ultrasound in detecting hepatic steatosis [14][15][16][17][18][19][20][21] and the fact that steatosis was noted on ultrasound examination in all of our patients with NASH and none of the controls using the same equipment and operators, the likelihood of missing more than very small amounts of steatosis seems unlikely. Several possible BMI-matched controls were excluded from this study because of ultrasound images characteristic of steatosis.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic ultrasound has been shown in prospective studies to have a sensitivity for hepatic steatosis of between 93% and 100%. [14][15][16][17][18][19][20][21] Obese controls were within 10% of the mean BMI of patients with NASH. Lean controls had BMIs within 10% of the ideal for age.…”

Section: Subjectsmentioning

confidence: 99%

Apolipoprotein synthesis in nonalcoholic steatohepatitis

et al. 2002

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The pathophysiology of hepatic steatosis, a prerequisite of nonalcoholic fatty liver disease, is poorly understood. Because very-low-density lipoprotein (VLDL) formation is the chief route of hepatic lipid export, we hypothesized that the synthesis of apoB-100, a rate-determining step in hepatic VLDL formation, may be altered in patients with nonalcoholic steatohepatitis (NASH). This study evaluated the relative synthesis rates of apolipoprotein B-100 (apoB-100) in patients with NASH and in lean and body mass index (BMI)-matched (obese) controls without NASH. A primed continuous infusion of L-[1-13 C] leucine was used to measure the absolute synthesis rates (ASR) of apoB-100 and fibrinogen in 7 patients with NASH and compared them with 7 lean and 7 obese (BMI-matched) controls without NASH. The ASRs of fibrinogen and albumin also were measured. The mean ASR of apoB-100 in patients with NASH was lower (31.5 ؎ 3.4 mg/kg/d) than that of obese (115.2 ؎ 7.2 mg/kg/d, P < .001) and lean controls (82.4 ؎ 4.1 mg/kg/d, P ‫؍‬ .002). In contrast, the mean ASR of fibrinogen was greater in subjects with NASH than in both control groups. These data indicate that NASH is associated with markedly altered hepatic synthesis of apoB-100. The finding that albumin synthesis was not similarly decreased in patients with NASH shows that the attenuation of apoB-100 synthesis is not on the basis of globally impaired hepatic protein synthesis. In conclusion, because apoB-100 synthesis is a rate-determining step in hepatocyte lipid export, decreased synthesis of this protein may be an important factor in the development of hepatic steatosis, a prerequisite for NASH. (HEPATOLOGY 2002;35:898-904.) N on-alcoholic steatohepatitis (NASH; part of the spectrum of nonalcoholic fatty liver disease) is characterized by macrovesicular steatosis, nuclear glycogenation, lobular and portal inflammation, and, occasionally, Mallory's hyaline, in the absence of excessive alcohol ingestion. 1 NASH is most frequently associated with obesity 2-9 and type 2 diabetes mellitus. 3,[7][8][9] Despite the high prevalence and the increasingly recognized morbidity associated with NASH, little is known about the pathophysiology of this condition. The liver is central to the regulation of fat metabolism, and the net accumulation of fat within hepatocytes, a prerequisite for steatosis and steatohepatitis, could potentially result from alterations in the uptake, synthesis, degradation, or secretory pathways of hepatic lipid metabolism.Apolipoprotein B-100 (apoB-100) is a large protein (512 kd) involved in the transport of triglycerides and cholesterol from the liver to peripheral tissues. Lipids are chiefly exported from the liver in the form of very-lowdensity lipoproteins (VLDL), a complex of protein (apoB-100), lipids (triglycerides or cholesteryl esters), and phospholipids. Although the mechanisms regulating the synthesis of apoB-100 are incompletely understood, the production of apoB-100 messenger RNA (mRNA) has been shown to be altered by insulin and unaffected by...

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“…Unenhanced CT shows low attenuation of the steatotic liver in contrast to the spleen, and the severity of steatosis correlates with the liver-spleen attenuation ratio [18,19] . However, misdiagnosis can occur when other diffuse liver conditions are present, such as hemochromatosis [20] . Furthermore, CT cannot detect the degree of fibrosis, and cannot distinguish NASH from simple steatosis [21] .…”

Section: Computed Tomographymentioning

confidence: 99%

“…Loomba et al [64] prospectively assessed the accuracy of MRE for predicting advanced fibrosis in 117 patients with biopsy-proven NAFLD; a threshold of > 3.63 kPa had a sensitivity of 86%, specificity of 91%, PPV of 68%, and NPV of 97%. Simple steatosis can be differentiated from NASH with an accuracy of 93% using a cutoff value of 2.74 kPa [20] , whereas NASH with advanced fibrosis can be detected with 95.4% accuracy using a cutoff value of 4.15 kPa [65] . The most frequent reason for technical failure in MRE is hepatic iron overload, which can decrease hepatic signal intensity in gradient echo-based MRE sequences to unacceptably low levels [61] .…”

Section: Magnetic Resonance-based Elastographymentioning

confidence: 99%