Noninvasive assessment of macrovesicular liver steatosis in cadaveric donors based on computed tomography liver‐to‐spleen attenuation ratio

Abstract

Fatty liver disease, including liver steatosis, is a major health problem worldwide. In liver transplantation, macrovesicular steatosis in donor livers is a major cause of graft failure and remains difficult to assess. On one hand, several imaging modalities can be used for the assessment of liver fat, but liver biopsy, which is still considered the gold standard, may be difficult to perform in this context. On the other hand, computed tomography (CT) is commonly used by teams managing cadaveric donors to assess donors and to minimize the risk of complications in recipients. The purpose of our study was to validate the use of CT as a semiquantitative method for assessing macrovesicular steatosis in cadaveric donors with liver biopsy as a reference standard. A total of 109 consecutive cadaveric donors were included between October 2009 and May 2011. Brain death was diagnosed according to French legislation. Liver biopsy and then CT were performed on the same day to determine the degree of macrovesicular steatosis. All liver biopsies and CT scans were analyzed in a double-blinded fashion by a senior pathologist and a senior radiologist, respectively. For CT, we used the liver-to-spleen (L/S) attenuation ratio, which is a validated method for determining 30% or greater steatosis in living liver donors. Fourteen of 109 biopsies exhibited macrovesicular steatosis > 30% upon histologic analysis. A receiver operating characteristic curve was generated for the L/S ratio to identify its ability to predict significant steatosis, which was defined as >30%. A cutoff value of 0.9 for the CT L/S ratio provided a sensitivity of 79% and a specificity of 97% to detect significant steatosis. Liver Transpl 21:690-695, 2015. V C 2015 AASLD.

NAFLD and liver transplantation: Current burden and expected challenges

“…However, among 492 living liver donors with normal transaminases and no evidence of steatosis at ultrasound, the prevalence of moderate to severe steatosis was 10% and 0.6% [59]. Computed tomography liver-to-spleen attenuation ratio is a reliable method to detect significant steatosis of >30% (sensitivity of 79% and specificity of 97%) [60]. However, these methods do not allow the qualitative assessment of steatosis and do not distinguish between microvesicular and macrovesicular steatosis.…”

Computer-assisted liver graft steatosis assessment via learning-based texture analysis

“…Considering challenges in diagnosis, preliminary efforts to the automated or semi-automated HS assessment have been proposed and a complete review can be found in [9]. Examples include [28], which reported a sensitivity (Se) of 79% in recognizing the HS level from computer-tomography (CT) images, and [19] which reported an area under the receiving operating characteristic curve of 75% by exploiting fibroscanning. Liver-bioelectrical-impedance analysis and Raman spectroscopy were used in [1] and [11], respectively.…”

Accuracy of computed tomography for detecting hepatic steatosis in donors for liver transplantation: A meta‐analysis

“…Only one study included brain‐dead donors, while others all included living liver donors. As for the study design, six studies were prospective, five were retrospective, and another one remained unclear . All studies enrolled donor candidates consecutively except three of them .…”

“…Then we conducted sensitivity analyses. We excluded the Rogier et al . study with the only brain‐dead donor type in the only non‐Asian country, Kim et al .…”