Living Donor Liver Transplantation

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

“…Quantitative methods of measuring liver echogenicity are always unreliable [27,28] but quantitative calculation of hepatosteatosis is more accurate than the qualitative assessment of hepatosteatosis on US. The ratios of the quantitative assessment were 77%, 77% and 71% as the sensitivity, specificity and diagnostic accuracy, respectively, in comparison with 60%-100%, 77%-95% and 96% for qualitative assessment [15,17,28] . Despite the benefits of US, such as being noninvasive, widely available, low cost, ease of clinician use and interpretation, it has some limitations, such as a small field of view, limited use in accompanying chronic liver disease, inability to distinguish degree of fibrosis, cirrhosis and NASH, operator and equipment dependence, limited use in obese patients and low sensitivity when hepatosteatosis is less than 20%-30% [15,29] .…”

“…The ratios of the quantitative assessment were 77%, 77% and 71% as the sensitivity, specificity and diagnostic accuracy, respectively, in comparison with 60%-100%, 77%-95% and 96% for qualitative assessment [15,17,28] . Despite the benefits of US, such as being noninvasive, widely available, low cost, ease of clinician use and interpretation, it has some limitations, such as a small field of view, limited use in accompanying chronic liver disease, inability to distinguish degree of fibrosis, cirrhosis and NASH, operator and equipment dependence, limited use in obese patients and low sensitivity when hepatosteatosis is less than 20%-30% [15,29] . In a recent study, Iijima et al [30] used an US contrast matter (Levovist; Sherling, Berlin) to distinguish between simple hepatosteatosis and NASH.…”

“…Nonsteatotic liver parenchyma shows homogeneous echo texture with similar or a bit higher echogenicity when compared to the kidney cortex and spleen parenchyma. Fatty liver shows echogenicity (bright liver) greater than the kidney cortex and spleen parenchyma due to intracellular accumulation of fat vacuoles [3,15,17] . In addition, US findings of fatty liver include hepatomegaly and vascular blurring of the portal or hepatic vein [4] .…”

“…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.…”

“…US is the primary imaging method used to determine and identify the fatty liver [15] . US is widely used for screening asymptomatic patients with increased liver enzymes and suspected NAFLD.…”