The Diagnosis of Acute Fatty Liver of Pregnancy by Computed Tomography

Rl, Goodacre; Hunter, D.J.; Millward, S.F.; Pirani, M; Rh, Riddell

doi:10.1097/00004836-198812000-00023

Cited by 12 publications

(7 citation statements)

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“…This observation, com bined with other reports [6][7][8][9][10] that reduced liver CT numbers are obtained in acute fatty liver of pregnancy, led to the expectation that liver-spleen CT number ratios obtained in the early postpartum period in patients with HELLP syndrome would be substantially decreased. However, only 3 cases with more severe thrombocytope nia showed a slight decrease in liver-spleen CT number ratios, suggesting the presence of fatty liver [11], Although liver specimens were not obtained from any of our patients for ethical reasons [12], these 3 patients might have had livers with a wider distribution of relatively large fat droplets [5].…”

Section: Discussionmentioning

confidence: 63%

“…Marked reductions in liver-spleen CT number ratios have been reported in acute fatty liver of pregnancy [6][7][8][9][10], but those patients experienced truly severe clinical conditions, such as jaundice, coagulopathy, mental deteri oration, and/or intrauterine fetal death. Their clinical condition could have been linked to a delay in medical intervention [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…It is unlikely that the CT number of liver is largely affected by parturition itself in several days. A marked reduction in liver CT number, which reflects massive fatty infiltration [6][7][8][9], can occur rapidly in severe clinical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Liver histology in both conditions is the same and is characterized by fatty infil tration of the hepatocytes [5], There have been several iso lated reports of acute fatty liver of pregnancy diagnosed by computed tomography (CT) that showed a reduced liv er-spleen CT number ratio [6][7][8][9][10], However, no systemat ic study has been reported on the clinical usefulness of antenatal determination of the liver-spleen CT number ratio in patients who are at risk for peripartum HELLP syndrome. We designed this study to resolve the issue.…”

Section: Introductionmentioning

confidence: 99%

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HELLP Syndrome: CT Evaluation

Minakami

Sugimoto²,

Manaka³

et al. 1994

Gynecol Obstet Invest

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Patients with the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) require careful observation and expedient delivery. However, those who develop this syndrome peripartum do not always fulfill its diagnostic criteria before labor begins. We investigated the potential usefulness of liver and spleen CT evaluation in identifying such patients. Seven patients with this syndrome were studied by CT scanning on postpartum days 0–3 and again 3–4 weeks after delivery. Although 3 patients with severe thrombocytopenia had a reduced liver-spleen CT number ratio (< 1.1) and subsequent normalization, the remaining 4 with less severe thrombocytopenia demonstrated no CT changes. Thus, antepartum evaluation of liver and spleen by CT may not be sensitive enough to detect patients who develop HELLP syndrome during the peripartum period. Serial examination of platelet counts may be more useful than CT in detecting patients at risk for this peripartum syndrome.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HELLP Syndrome: CT Evaluation

Minakami

Sugimoto²,

Manaka³

et al. 1994

Gynecol Obstet Invest

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“…Ultrasonography of the liver may show increased echogenicity [89]. CT may be useful for the diagnosis, and a liver density that is lower than usual may be demonstrated by Hounsfield unit values in the liver that are equal to or lower than those in the spleen [90]. The findings on imaging studies may be normal, however; a study showed that the findings on CT, which is more sensitive than ultrasonography, were normal in half of patients with AFLP [91].…”

Section: Clinical and Biochemical Findingsmentioning

confidence: 99%

The Liver in Pregnancy

Bacq

2011

Schiff's Diseases of the Liver

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Choline deficiency: A cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation

et al. 1995

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Patients receiving long-term total parenteral nutrition (TPN) develop hepatic steatosis as a complication. Our previous studies have shown this to be caused, at least in part, by choline deficiency. We studied four patients (1 man, 3 women) aged 50 +/- 13 years who had low plasma-free choline concentrations 4.8 +/- 1.7 (normal, 11.4 +/- 3.7 nmol/mL). The patients had received TPN for 9.7 +/- 4.7 years. They received parenteral nutrition solutions containing choline chloride (1 to 4 g/d) for 6 weeks. Abdominal computed tomography (CT) was performed at baseline, biweekly during the choline supplementation, and 4 weeks after discontinuation of choline. During choline administration, the plasma-free choline concentration increased into the normal range within 1 week in all four patients and remained at or above the normal range for all 6 weeks, but decreased back to baseline when choline supplementation was discontinued. Hepatic steatosis resolved completely, as estimated by CT. Liver density increased from -14.2 +/- 22.3 Hounsfield units (HU) to 8.4 +/- 10.3 HU at week 2 (P = .002); 9.6 +/- 10.7 HU at week 4 and 13.1 +/- 7.3 HU at week 6, as determined by the liver-spleen CT number difference obtained by the subtraction of the average spleen CT number (in HU) from the average liver CT number. This improvement continued up to 4 weeks after choline supplementation (13.8 +/- 2.8 HU). Hepatic steatosis was shown to have recurred in one patient after 10 weeks of return to choline-free parenteral nutrition. The hepatic steatosis associated with parenteral nutrition can be ameliorated, and possibly prevented, with choline supplementation. Therefore, choline may be an essential nutrient for patients who require long-term parenteral nutrition.

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The Diagnosis of Acute Fatty Liver of Pregnancy by Computed Tomography

Cited by 12 publications

References 0 publications

HELLP Syndrome: CT Evaluation

HELLP Syndrome: CT Evaluation

The Liver in Pregnancy

Choline deficiency: A cause of hepatic steatosis during parenteral nutrition that can be reversed with intravenous choline supplementation

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