Detection of Hepatic Steatosis on Contrast-Enhanced CT Images: Diagnostic Accuracy of Identification of Areas of Presumed Focal Fatty Sparing

• Published in: American journal of roentgenology (1976) Vol. 199; no. 1; pp. 44 - 47
• Main Authors: Lawrence, David A., Oliva, Isabel B., Israel, Gary M.
• Format: Journal Article
• Language: English
• Published: Reston, VA American Roentgen Ray Society 01.07.2012
• Subjects: Biological and medical sciences; Contrast Media; Fatty Liver - diagnosis; Fatty Liver - diagnostic imaging; Fatty Liver - physiopathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver - diagnostic imaging; Liver - physiopathology; Liver Function Tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Observer Variation; Other diseases. Semiology; Predictive Value of Tests; Radiographic Image Enhancement - methods; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Nuclear medicine; aberrant venous drainage; Radiodiagnosis; Hepatic disease; hepatic steatosis; Drainage; focal fatty sparing; Fatty liver; Blood vessel; Radiology; Medical imagery; Digestive diseases; Computerized axial tomography; Circulatory system; Diagnosis; Vein
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.11.7838

The purpose of this article is to determine the diagnostic accuracy of identifying focal areas of increased density along the gallbladder fossa or in the periphery of segment IV for diagnosing hepatic steatosis. Five hundred consecutive three-phase CT examinations were retrospectively evaluated. Two reference standards for hepatic steatosis were determined using the unenhanced CT examination: a liver-spleen attenuation difference of greater than 10 HU and the absolute attenuation of the liver less than 40 HU. The portal venous phase was independently analyzed by two radiologists. Hepatic steatosis was diagnosed on the contrast-enhanced images if there was increased attenuation in the liver, either at the gallbladder fossa or in the posterior medial aspect of segment IV, when compared with background liver parenchyma. The criterion of relative liver-spleen attenuation difference diagnosed 38 cases. The criterion of absolute liver attenuation less than 40 HU diagnosed 44 cases. Of these cases, hepatic steatosis was diagnosed on the portal venous phase in 23 cases (κ = 1.0), with no false-positive cases. The criterion of relative liver-spleen attenuation difference yielded sensitivity, specificity, positive predictive value, and negative predictive value of 60.5%, 100%, 100%, and 96.9%, respectively. The criterion of absolute liver attenuation less than 40 HU yielded sensitivity, specificity, positive predictive value, and negative predictive value of 52.5%, 100%, 100%, and 95.7%, respectively. Qualitative evaluation of the liver on a portal venous phase contrast-enhanced CT is highly specific for the diagnosis of hepatic steatosis; the sensitivity of the method, however, is rather low.