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Kim HY, Lee KJ, Lee SS, Choi SJ, Kim DH, Heo S, Jang HJ, Choi SH. Diagnosis of moderate-to-severe hepatic steatosis using deep learning-based automated attenuation measurements on contrast-enhanced CT. Abdom Radiol (NY) 2025:10.1007/s00261-025-04872-5. [PMID: 40095018 DOI: 10.1007/s00261-025-04872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/26/2025] [Accepted: 03/02/2025] [Indexed: 03/19/2025]
Abstract
PURPOSE To evaluate the utility of deep learning-based automated attenuation measurements on contrast-enhanced CT (CECT) for diagnosing moderate-to-severe hepatic steatosis (HS), using histology as reference standard. METHODS This retrospective study included 3,620 liver donors (2,393 men and 1,227 women; mean age, 31.7 ± 9.4 years), divided into the development (n = 2,714) and test (n = 906) cohorts. Attenuation values of the liver and spleen on CECT were measured both manually and using a deep learning algorithm (before and after radiologists' correction of segmentation errors). Performance of: (1) liver attenuation and (2) liver-spleen attenuation difference for diagnosing moderate-to-severe HS (> 33%) was assessed using the area under the receiver operating characteristic curve (AUC). Three different criteria targeting 95% sensitivity, 95% specificity, and the maximum Youden's index, respectively, for diagnosing moderate-to-severe HS, were developed and validated. RESULTS The performance of deep learning-based measurements did not differ significantly, with or without radiologists' corrections (p = 0.13). Liver-spleen attenuation difference outperformed liver attenuation alone in diagnosing moderate-to-severe HS in both deep learning-based (AUC, 0.868 vs. 0.821; p = 0.001) and manual (AUC, 0.871 vs. 0.823; p = 0.001) measurements. In the test cohort, the criterion targeting 95% sensitivity for diagnosing moderate-to-severe HS (liver-spleen attenuation difference ≤ 2.8 HU) yielded 92.0% (69/75) sensitivity and 48.5% (403/831) specificity. The criterion targeting 95% specificity (liver-spleen attenuation difference ≤ -18.8 HU) yielded 53.3% (40/75) sensitivity and 95.7% (795/831) specificity. The criterion targeting the maximum Youden's index (liver-spleen attenuation difference ≤ -8.2 HU) yielded 82.7% (62/75) sensitivity and 80.7% (671/831) specificity. CONCLUSION Deep learning-based automated measurements of liver and spleen attenuation on CECT can be used reliably to detect moderate-to-severe HS.
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Affiliation(s)
- Hae Young Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Jin Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Soo Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Se Jin Choi
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Subin Heo
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeon Ji Jang
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Pickhardt PJ, Lubner MG. Noninvasive Quantitative CT for Diffuse Liver Diseases: Steatosis, Iron Overload, and Fibrosis. Radiographics 2025; 45:e240176. [PMID: 39700040 DOI: 10.1148/rg.240176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
Chronic diffuse liver disease continues to increase in prevalence and represents a global health concern. Noninvasive detection and quantification of hepatic steatosis, iron overload, and fibrosis are critical, especially given the many relative disadvantages and potential risks of invasive liver biopsy. Although MRI techniques have emerged as the preferred reference standard for quantification of liver fat, iron, and fibrosis, CT can play an important role in opportunistic detection of unsuspected disease and is performed at much higher volumes. For hepatic steatosis, noncontrast CT provides a close approximation to MRI-based proton-density fat fraction (PDFF) quantification, with liver attenuation values less than or equal to 40 HU signifying at least moderate steatosis. Liver fat quantification with postcontrast CT is less precise but can generally provide categorical assessment (eg, mild vs moderate steatosis). Noncontrast CT can also trigger appropriate assessment for iron overload when increased parenchymal attenuation values are observed (eg, >75 HU). A variety of morphologic and functional CT features indicate the presence of underlying hepatic fibrosis and cirrhosis. Beyond subjective assessment, quantitative CT methods for staging fibrosis can provide comparable performance to that of elastography. Furthermore, quantitative CT assessment can be performed retrospectively, since prospective techniques are not required. Many of these CT quantitative measures are now fully automated via artificial intelligence (AI) deep learning algorithms. These retrospective and automated advantages have important implications for longitudinal clinical care and research. Ultimately, regardless of the indication for CT, opportunistic detection of steatosis, iron overload, and fibrosis can result in appropriate clinical awareness and management. ©RSNA, 2024 See the invited commentary by Yeh in this issue.
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Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/311 Clinical Science Center, Madison, WI 53792-3252; and the American College of Radiology (ACR) Institute for Radiologic Pathology, Silver Spring, Md
| | - Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/311 Clinical Science Center, Madison, WI 53792-3252; and the American College of Radiology (ACR) Institute for Radiologic Pathology, Silver Spring, Md
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Haghshomar M, Antonacci D, Smith AD, Thaker S, Miller FH, Borhani AA. Diagnostic Accuracy of CT for the Detection of Hepatic Steatosis: A Systematic Review and Meta-Analysis. Radiology 2024; 313:e241171. [PMID: 39499183 DOI: 10.1148/radiol.241171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2024]
Abstract
Background CT plays an important role in the opportunistic identification of hepatic steatosis. CT performance for steatosis detection has been inconsistent across various studies, and no clear guidelines on optimum thresholds have been established. Purpose To conduct a systematic review and meta-analysis to assess CT diagnostic accuracy in hepatic steatosis detection and to determine reliable cutoffs for the commonly mentioned measures in the literature. Materials and Methods A systematic search of the PubMed, Embase, and Scopus databases (English-language studies published from September 1977 to January 2024) was performed. Studies evaluating the diagnostic accuracy of noncontrast CT (NCCT), contrast-enhanced (CECT), and dual-energy CT (DECT) for hepatic steatosis detection were included. Reference standards included biopsy, MRI proton density fat fraction (PDFF), or NCCT. In several CECT and DECT studies, NCCT was used as the reference standard, necessitating subgroup analysis. Statistical analysis included a random-effects meta-analysis, assessment of heterogeneity with use of the I2 statistic, and meta-regression to explore potential sources of heterogeneity. When available, mean liver attenuation, liver-spleen attenuation difference, liver to spleen attenuation ratio, and the DECT-derived fat fraction for hepatic steatosis diagnosis were assessed. Results Forty-two studies (14 186 participants) were included. NCCT had a sensitivity and specificity of 72% and 88%, respectively, for steatosis (>5% fat at biopsy) detection and 82% and 94% for at least moderate steatosis (over 20%-33% fat at biopsy) detection. CECT had a sensitivity and specificity of 66% and 90% for steatosis detection and 68% and 93% for at least moderate steatosis detection. DECT had a sensitivity and specificity of 85% and 88% for steatosis detection. In the subgroup analysis, the sensitivity and specificity for detecting steatosis were 80% and 99% for CECT and 84% and 93% for DECT. There was heterogeneity among studies focusing on CECT and DECT. Liver attenuation less than 40-45 HU, liver-spleen attenuation difference less than -5 to 0 HU, and liver to spleen attenuation ratio less than 0.9-1 achieved high specificity for detection of at least moderate steatosis. Conclusion NCCT showed high performance for detection of at least moderate steatosis. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Maryam Haghshomar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Arkes Family Pavilion, Ste 800, Chicago, IL 60611 (M.H., D.A., S.T., F.H.M., A.A.B.); and Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tenn (A.D.S.)
| | - Dominic Antonacci
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Arkes Family Pavilion, Ste 800, Chicago, IL 60611 (M.H., D.A., S.T., F.H.M., A.A.B.); and Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tenn (A.D.S.)
| | - Andrew D Smith
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Arkes Family Pavilion, Ste 800, Chicago, IL 60611 (M.H., D.A., S.T., F.H.M., A.A.B.); and Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tenn (A.D.S.)
| | - Sarang Thaker
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Arkes Family Pavilion, Ste 800, Chicago, IL 60611 (M.H., D.A., S.T., F.H.M., A.A.B.); and Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tenn (A.D.S.)
| | - Frank H Miller
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Arkes Family Pavilion, Ste 800, Chicago, IL 60611 (M.H., D.A., S.T., F.H.M., A.A.B.); and Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tenn (A.D.S.)
| | - Amir A Borhani
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Arkes Family Pavilion, Ste 800, Chicago, IL 60611 (M.H., D.A., S.T., F.H.M., A.A.B.); and Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tenn (A.D.S.)
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Pickhardt PJ, Blake GM, Moeller A, Garrett JW, Summers RM. Post-contrast CT liver attenuation alone is superior to the liver-spleen difference for identifying moderate hepatic steatosis. Eur Radiol 2024; 34:7041-7052. [PMID: 38834787 DOI: 10.1007/s00330-024-10816-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To assess the diagnostic performance of post-contrast CT for predicting moderate hepatic steatosis in an older adult cohort undergoing a uniform CT protocol, utilizing hepatic and splenic attenuation values. MATERIALS AND METHODS A total of 1676 adults (mean age, 68.4 ± 10.2 years; 1045M/631F) underwent a CT urothelial protocol that included unenhanced, portal venous, and 10-min delayed phases through the liver and spleen. Automated hepatosplenic segmentation for attenuation values (in HU) was performed using a validated deep-learning tool. Unenhanced liver attenuation < 40.0 HU, corresponding to > 15% MRI-based proton density fat, served as the reference standard for moderate steatosis. RESULTS The prevalence of moderate or severe steatosis was 12.9% (216/1676). The diagnostic performance of portal venous liver HU in predicting moderate hepatic steatosis (AUROC = 0.943) was significantly better than the liver-spleen HU difference (AUROC = 0.814) (p < 0.001). Portal venous phase liver thresholds of 80 and 90 HU had a sensitivity/specificity for moderate steatosis of 85.6%/89.6%, and 94.9%/74.7%, respectively, whereas a liver-spleen difference of -40 HU and -10 HU had a sensitivity/specificity of 43.5%/90.0% and 92.1%/52.5%, respectively. Furthermore, livers with moderate-severe steatosis demonstrated significantly less post-contrast enhancement (mean, 35.7 HU vs 47.3 HU; p < 0.001). CONCLUSION Moderate steatosis can be reliably diagnosed on standard portal venous phase CT using liver attenuation values alone. Consideration of splenic attenuation appears to add little value. Moderate steatosis not only has intrinsically lower pre-contrast liver attenuation values (< 40 HU), but also enhances less, typically resulting in post-contrast liver attenuation values of 80 HU or less. CLINICAL RELEVANCE STATEMENT Moderate steatosis can be reliably diagnosed on post-contrast CT using liver attenuation values alone. Livers with at least moderate steatosis enhance less than those with mild or no steatosis, which combines with the lower intrinsic attenuation to improve detection. KEY POINTS The liver-spleen attenuation difference is frequently utilized in routine practice but appears to have performance limitations. The liver-spleen attenuation difference is less effective than liver attenuation for moderate steatosis. Moderate and severe steatosis can be identified on standard portal venous phase CT using liver attenuation alone.
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Affiliation(s)
- Perry J Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Alex Moeller
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - John W Garrett
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
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Yoo J, Joo I, Jeon SK, Park J, Yoon SH. Utilizing fully-automated 3D organ segmentation for hepatic steatosis assessment with CT attenuation-based parameters. Eur Radiol 2024; 34:6205-6213. [PMID: 38393403 PMCID: PMC11364604 DOI: 10.1007/s00330-024-10660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/22/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To investigate the clinical utility of fully-automated 3D organ segmentation in assessing hepatic steatosis on pre-contrast and post-contrast CT images using magnetic resonance spectroscopy (MRS)-proton density fat fraction (PDFF) as reference standard. MATERIALS AND METHODS This retrospective study analyzed 362 adult potential living liver donors with abdominal CT scans and MRS-PDFF. Using a deep learning-based tool, mean volumetric CT attenuation of the liver and spleen were measured on pre-contrast (liver(L)_pre and spleen(S)_pre) and post-contrast (L_post and S_post) images. Agreements between volumetric and manual region-of-interest (ROI)-based measurements were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Diagnostic performances of volumetric parameters (L_pre, liver-minus-spleen (L-S)_pre, L_post, and L-S_post) were evaluated for detecting MRS-PDFF ≥ 5% and ≥ 10% using receiver operating characteristic (ROC) curve analysis and compared with those of ROI-based parameters. RESULTS Among the 362 subjects, 105 and 35 had hepatic steatosis with MRS-PDFF ≥ 5% and ≥ 10%, respectively. Volumetric and ROI-based measurements revealed ICCs of 0.974, 0.825, 0.992, and 0.962, with mean differences of -4.2 HU, -3.4 HU, -1.2 HU, and -7.7 HU for L_pre, S_pre, L_post, and S_post, respectively. Volumetric L_pre, L-S_pre, L_post, and L-S_post yielded areas under the ROC curve of 0.813, 0.813, 0.734, and 0.817 for MRS-PDFF ≥ 5%; and 0.901, 0.915, 0.818, and 0.868 for MRS-PDFF ≥ 10%, comparable with those of ROI-based parameters (0.735-0.818; and 0.816-0.895, Ps = 0.228-0.911). CONCLUSION Automated 3D segmentation of the liver and spleen in CT scans can provide volumetric CT attenuation-based parameters to detect and grade hepatic steatosis, applicable to pre-contrast and post-contrast images. CLINICAL RELEVANCE STATEMENT Volumetric CT attenuation-based parameters of the liver and spleen, obtained through automated segmentation tools from pre-contrast or post-contrast CT scans, can efficiently detect and grade hepatic steatosis, making them applicable for large population data collection. KEY POINTS • Automated organ segmentation enables the extraction of CT attenuation-based parameters for the target organ. • Volumetric liver and spleen CT attenuation-based parameters are highly accurate in hepatic steatosis assessment. • Automated CT measurements from pre- or post-contrast imaging show promise for hepatic steatosis screening in large cohorts.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Junghoan Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- MEDICALIP. Co. Ltd., Seoul, Korea
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Jeon SK, Joo I, Park J, Yoo J. Automated hepatic steatosis assessment on dual-energy CT-derived virtual non-contrast images through fully-automated 3D organ segmentation. LA RADIOLOGIA MEDICA 2024; 129:967-976. [PMID: 38869829 PMCID: PMC11252222 DOI: 10.1007/s11547-024-01833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To evaluate the efficacy of volumetric CT attenuation-based parameters obtained through automated 3D organ segmentation on virtual non-contrast (VNC) images from dual-energy CT (DECT) for assessing hepatic steatosis. MATERIALS AND METHODS This retrospective study included living liver donor candidates having liver DECT and MRI-determined proton density fat fraction (PDFF) assessments. Employing a 3D deep learning algorithm, the liver and spleen were automatically segmented from VNC images (derived from contrast-enhanced DECT scans) and true non-contrast (TNC) images, respectively. Mean volumetric CT attenuation values of each segmented liver (L) and spleen (S) were measured, allowing for liver attenuation index (LAI) calculation, defined as L minus S. Agreements of VNC and TNC parameters for hepatic steatosis, i.e., L and LAI, were assessed using intraclass correlation coefficients (ICC). Correlations between VNC parameters and MRI-PDFF values were assessed using the Pearson's correlation coefficient. Their performance to identify MRI-PDFF ≥ 5% and ≥ 10% was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Of 252 participants, 56 (22.2%) and 16 (6.3%) had hepatic steatosis with MRI-PDFF ≥ 5% and ≥ 10%, respectively. LVNC and LAIVNC showed excellent agreement with LTNC and LAITNC (ICC = 0.957 and 0.968) and significant correlations with MRI-PDFF values (r = - 0.585 and - 0.588, Ps < 0.001). LVNC and LAIVNC exhibited areas under the ROC curve of 0.795 and 0.806 for MRI-PDFF ≥ 5%; and 0.916 and 0.932, for MRI-PDFF ≥ 10%, respectively. CONCLUSION Volumetric CT attenuation-based parameters from VNC images generated by DECT, via automated 3D segmentation of the liver and spleen, have potential for opportunistic hepatic steatosis screening, as an alternative to TNC images.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center Seoul National University Hospital, Seoul, Korea.
| | - Junghoan Park
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
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D'Cruz V, De Zutter A, Van den Broecke M, Ribeiro S, Abreu de Carvalho L, Smeets P, Lecluyse C, Pape E, Callebout E, Berrevoet F, Geboes K. Prevalence of metabolic dysfunction-associated fatty liver disease after pancreatic surgery in a historical Belgian cohort and review of the literature. Acta Gastroenterol Belg 2024; 87:373-380. [PMID: 39411790 DOI: 10.51821/87.3.10078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Background and objectives Metabolic dysfunction-associated fatty liver disease (MAFLD) has been reported as a complication after pancreatic surgery. The aim of this study is to assess this phenomenon in a Belgian population, specifically in a period in time when less perioperative chemotherapy was given. Methods We performed a retrospective monocentric cohort study with 124 selected patients who underwent pancreatic surgery - pancreaticoduodenectomy (PD), distal pancreatectomy (DP) or total pancreatectomy - between 2005 and 2014. Steatosis was assessed radiologically, using Hounsfield units on liver and spleen. Data on imaging, liver function, weight and other relevant parameters were gathered preoperatively as well as 2 and 6 months, 1 and 2 years after surgery. Results Thirty-eight (31%) out of 124 patients developed liver steatosis at least at one point in time in the two years following surgery, with a prevalence of 21.0% at 2 months, 28.6% at 6 months, 16.4% at 1 year and 20.8 % at 2 years. A statistically significant association with preoperative AST and ALT values, administration of pancreatic enzyme supplementation as a surrogate for pancreatic exocrine insufficiency (PEI) and weight loss at 2 years was detected. Conclusion MAFLD is seen in 31% of patients with PD or DP pancreatic resection in this retrospective analysis of a monocentric Belgian cohort. Both early and late onset of MAFLD was observed, implying that long-term follow-up is necessary. Clinical impact as well as a direct correlation with patients' weight and oral enzyme supplements needs to be further investigated.
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Affiliation(s)
- V D'Cruz
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
| | - A De Zutter
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
- Sint-Andriesziekenhuis, department of Gastroenterology, Tielt, Belgium
| | - M Van den Broecke
- Ghent University Hospital, department of Radiology, Ghent, Belgium
- Sint Vincentiusziekenhuis, department of Radiology, Deinze, Belgium
| | - S Ribeiro
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
| | - L Abreu de Carvalho
- Ghent University Hospital, General and HPB Surgery and Liver Transplantation, Ghent, Belgium
| | - P Smeets
- Ghent University Hospital, department of Radiology, Ghent, Belgium
| | - C Lecluyse
- Ghent University Hospital, department of Radiology, Ghent, Belgium
| | - E Pape
- Ghent University Hospital, General and HPB Surgery and Liver Transplantation, Ghent, Belgium
| | - E Callebout
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
| | - F Berrevoet
- Ghent University Hospital, General and HPB Surgery and Liver Transplantation, Ghent, Belgium
| | - K Geboes
- Ghent University Hospital, department of Gastroenterology, Ghent, Belgium
- Ghent University Hospital, Cancer Centre, Ghent, Belgium
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Martín-Saladich Q, Pericàs JM, Ciudin A, Ramirez-Serra C, Escobar M, Rivera-Esteban J, Aguadé-Bruix S, González Ballester MA, Herance JR. Metabolic-associated fatty liver voxel-based quantification on CT images using a contrast adapted automatic tool. Med Image Anal 2024; 95:103185. [PMID: 38718716 DOI: 10.1016/j.media.2024.103185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/22/2023] [Accepted: 04/19/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND & AIMS Metabolic-dysfunction associated fatty liver disease (MAFLD) is highly prevalent and can lead to liver complications and comorbidities, with non-invasive tests such as vibration-controlled transient elastography (VCTE) and invasive liver biopsies being used for diagnosis The aim of the present study was to develop a new fully automatized method for quantifying the percentage of fat in the liver based on a voxel analysis on computed tomography (CT) images to solve previously unconcluded diagnostic deficiencies either in contrast (CE) or non-contrast enhanced (NCE) assessments. METHODS Liver and spleen were segmented using nn-UNet on CE- and NCE-CT images. Radiodensity values were obtained for both organs for defining the key benchmarks for fatty liver assessment: liver mean, liver-to-spleen ratio, liver-spleen difference, and their average. VCTE was used for validation. A classification task method was developed for detection of suitable patients to fulfill maximum reproducibility across cohorts and highlight subjects with other potential radiodensity-related diseases. RESULTS Best accuracy was attained using the average of all proposed benchmarks being the liver-to-spleen ratio highly useful for CE and the liver-to-spleen difference for NCE. The proposed whole-organ automatic segmentation displayed superior potential when compared to the typically used manual region-of-interest drawing as it allows to accurately obtain the percent of fat in liver, among other improvements. Atypical patients were successfully stratified through a function based on biochemical data. CONCLUSIONS The developed method tackles the current drawbacks including biopsy invasiveness, and CT-related weaknesses such as lack of automaticity, dependency on contrast agent, no quantification of the percentage of fat in liver, and limited information on region-to-organ affectation. We propose this tool as an alternative for individualized MAFLD evaluation by an early detection of abnormal CT patterns based in radiodensity whilst abording detection of non-suitable patients to avoid unnecessary exposure to CT radiation. Furthermore, this work presents a surrogate aid for assessing fatty liver at a primary assessment of MAFLD using elastography data.
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Affiliation(s)
- Queralt Martín-Saladich
- Nuclear Medicine, Radiology and Cardiology Departments, Medical Molecular Imaging Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; Department of Information and Communication Technologies, BCN MedTech, Universitat Pompeu Fabra, Barcelona 08018, Spain
| | - Juan M Pericàs
- Vall d'Hebron Institute for Research, Liver Unit, Vall d'Hebron University Hospital, Barcelona 08035, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Andreea Ciudin
- Endocrinology Department, Diabetes and Metabolism Research Group, VHIR, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Clara Ramirez-Serra
- Clinical Biochemistry Research Group, Vall d'Hebron Research Institute (VHIR), Biochemical Core Facilities, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain
| | - Manuel Escobar
- Nuclear Medicine, Radiology and Cardiology Departments, Medical Molecular Imaging Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain
| | - Jesús Rivera-Esteban
- Vall d'Hebron Institute for Research, Liver Unit, Vall d'Hebron University Hospital, Barcelona 08035, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Santiago Aguadé-Bruix
- Nuclear Medicine, Radiology and Cardiology Departments, Medical Molecular Imaging Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain
| | - Miguel A González Ballester
- Department of Information and Communication Technologies, BCN MedTech, Universitat Pompeu Fabra, Barcelona 08018, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona 08010, Spain
| | - José Raul Herance
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid 28029, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Madrid 28029, Spain.
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9
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Pickhardt PJ, Blake GM, Kimmel Y, Weinstock E, Shaanan K, Hassid S, Abbas A, Fox MA. Detection of Moderate Hepatic Steatosis on Portal Venous Phase Contrast-Enhanced CT: Evaluation Using an Automated Artificial Intelligence Tool. AJR Am J Roentgenol 2023; 221:748-758. [PMID: 37466185 DOI: 10.2214/ajr.23.29651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND. Precontrast CT is an established means of evaluating for hepatic steatosis; postcontrast CT has historically been limited for this purpose. OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance of portal venous phase postcontrast CT in detecting at least moderate hepatic steatosis using liver and spleen attenuation measurements determined by an automated artificial intelligence (AI) tool. METHODS. This retrospective study included 2917 patients (1381 men, 1536 women; mean age, 56.8 years) who underwent a CT examination that included at least two series through the liver. Examinations were obtained from an AI vendor's data lake of data from 24 centers in one U.S. health care network and 29 centers in one Israeli health care network. An automated deep learning tool extracted liver and spleen attenuation measurements. The reference for at least moderate steatosis was precontrast liver attenuation of less than 40 HU (i.e., estimated liver fat > 15%). A radiologist manually reviewed examinations with outlier AI results to confirm portal venous timing and identify issues impacting attenuation measurements. RESULTS. After outlier review, analysis included 2777 patients with portal venous phase images. Prevalence of at least moderate steatosis was 13.9% (387/2777). Patients without and with at least moderate steatosis, respectively, had mean postcontrast liver attenuation of 104.5 ± 18.1 (SD) HU and 67.1 ± 18.6 HU (p < .001); a mean difference in postcontrast attenuation between the liver and the spleen (hereafter, postcontrast liver-spleen attenuation difference) of -7.6 ± 16.4 (SD) HU and -31.8 ± 20.3 HU (p < .001); and mean liver enhancement of 49.3 ± 15.9 (SD) HU versus 38.6 ± 13.6 HU (p < .001). Diagnostic performance for the detection of at least moderate steatosis was higher for postcontrast liver attenuation (AUC = 0.938) than for the postcontrast liver-spleen attenuation difference (AUC = 0.832) (p < .001). For detection of at least moderate steatosis, postcontrast liver attenuation had sensitivity and specificity of 77.8% and 93.2%, respectively, at less than 80 HU and 90.5% and 78.4%, respectively, at less than 90 HU; the postcontrast liver-spleen attenuation difference had sensitivity and specificity of 71.4% and 79.3%, respectively, at less than -20 HU and 87.0% and 62.1%, respectively, at less than -10 HU. CONCLUSION. Postcontrast liver attenuation outperformed the postcontrast liver-spleen attenuation difference for detecting at least moderate steatosis in a heterogeneous patient sample, as evaluated using an automated AI tool. Splenic attenuation likely is not needed to assess for at least moderate steatosis on postcontrast images. CLINICAL IMPACT. The technique could promote early detection of clinically significant nonalcoholic fatty liver disease through individualized or large-scale opportunistic evaluation.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | | | | | | | | | - Ahmad Abbas
- Department of Radiology, Barzilai University Medical Center, Ashkelon, Israel
| | - Matthew A Fox
- Nanox-AI, Ltd., Neve Ilan, Israel
- Department of Radiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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10
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Boeriu A, Dobru D, Fofiu C. Non-Invasive Diagnostic of NAFLD in Type 2 Diabetes Mellitus and Risk Stratification: Strengths and Limitations. Life (Basel) 2023; 13:2262. [PMID: 38137863 PMCID: PMC10744403 DOI: 10.3390/life13122262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/26/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
The progressive potential of liver damage in type 2 diabetes mellitus (T2DM) towards advanced fibrosis, end-stage liver disease, and hepatocarcinoma has led to increased concern for quantifying liver injury and individual risk assessment. The combination of blood-based markers and imaging techniques is recommended for the initial evaluation in NAFLD and for regular monitoring to evaluate disease progression. Continued development of ultrasonographic and magnetic resonance imaging methods for accurate quantification of liver steatosis and fibrosis, as well as promising tools for the detection of high-risk NASH, have been noted. In this review, we aim to summarize available evidence regarding the usefulness of non-invasive methods for the assessment of NAFLD in T2DM. We focus on the power and limitations of various methods for diagnosis, risk stratification, and patient monitoring that support their implementation in clinical setting or in research field.
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Affiliation(s)
- Alina Boeriu
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania;
- Gastroenterology Department, Mures County Clinical Hospital, 540103 Targu Mures, Romania
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania;
- Gastroenterology Department, Mures County Clinical Hospital, 540103 Targu Mures, Romania
| | - Crina Fofiu
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania;
- Internal Medicine Department, Bistrita County Clinical Hospital, 420094 Bistrita, Romania
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11
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Prinz S, Murray JM, Strack C, Nattenmüller J, Pomykala KL, Schlemmer HP, Badde S, Kleesiek J. Novel measures for the diagnosis of hepatic steatosis using contrast-enhanced computer tomography images. Eur J Radiol 2023; 160:110708. [PMID: 36724687 DOI: 10.1016/j.ejrad.2023.110708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/23/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Hepatic steatosis is often diagnosed non-invasively. Various measures and accompanying diagnostic thresholds based on contrast-enhanced CT and virtual non-contrast images have been proposed. We compare these established criteria to novel and fully automated measures. METHOD CT data sets of 197 patients were analyzed. Regions of interest (ROIs) were manually drawn for the liver, spleen, portal vein, and aorta to calculate four established measures of liver-fat. Two novel measures capturing the deviation between the empirical distributions of HU measurements across all voxels within the liver and spleen were calculated. These measures were calculated with both manual ROIs and using fully automated organ segmentations. Agreement between the different measures was evaluated using correlational analysis, as well as their ability to discriminate between fatty and healthy liver. RESULTS Established and novel measures of fatty liver were at a high level of agreement. Novel methods were statistically indistinguishable from the established ones when taking established diagnostic thresholds or physicians' diagnoses as ground truth and this high performance level persisted for automatically selected ROIs. CONCLUSION Automatically generated organ segmentations led to comparable results as manual ROIs, suggesting that the implementation of automated methods can prove to be a valuable tool for incidental diagnosis. Differences in the distribution of HU measurements across voxels between liver and spleen can serve as surrogate markers for the liver-fat-content. Novel measures do not exhibit a measurable disadvantage over established methods based on simpler measures such as across-voxel averages in a population with low incidence of fatty liver.
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Affiliation(s)
- Sebastian Prinz
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany.
| | - Jacob M Murray
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany; Institute for AI in Medicine (IKIM), University Medicine Essen, 45131 Essen, Germany
| | - Christian Strack
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Kelsey L Pomykala
- Institute for AI in Medicine (IKIM), University Medicine Essen, 45131 Essen, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stephanie Badde
- Department of Psychology, Tufts University, 02511 Medford, MA, USA
| | - Jens Kleesiek
- Institute for AI in Medicine (IKIM), University Medicine Essen, 45131 Essen, Germany; German Cancer Consortium (DKTK), Partner Sites Heidelberg and Essen, 69120 Heidelberg, Germany; Cancer Research Center Cologne Essen, West German Cancer Center Essen, 45122 Essen, Germany
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12
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Comparison of Two 2.45 GHz Microwave Ablation Devices with Respect to Ablation Zone Volume in Relation to Applied Energy in Patients with Malignant Liver Tumours. Cancers (Basel) 2022; 14:cancers14225570. [PMID: 36428663 PMCID: PMC9688226 DOI: 10.3390/cancers14225570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: (i) to compare two 2.45 GHz MWA devices with respect to AZV in relation to the applied energy after MWA in patients with hepatocellular carcinoma (HCC) or colorectal liver metastasis (CRLM) and (ii) to identify potential confounders for this relationship. Methods: In total, 102 tumours, 65 CRLM and 37 HCC were included in this retrospective analysis. Tumours were treated with Emprint (n = 71) or Neuwave (n = 31) MWA devices. Ablation treatment setting were recorded and applied energy was calculated. AZV and tumour volumes were segmented on the contrast-enhanced CT scans obtained 1 week after treatment. The AZV to applied energy R(AZV:E) ratios were calculated for each tumour treatment and compared between both MWA devices and tumour types. Results: R(AZV:E)EMPRINT was 0.41 and R(AZV:E)NEUWAVE was 0.81, p < 0.001. Moderate correlation between AZV and applied energy was found for Emprint (r = 0.57, R2 = 0.32, p < 0.001) and strong correlation was found for Neuwave (r = 0.78, R2 = 0.61, p < 0.001). R(AZV:E)CRLM was 0.45 and R(AZV:E)HCC was 0.52, p = 0.270. Conclusion: This study confirms the unpredictability of AZVs based on the applied output energy for HCC and CRLM. No significant differences in R(AZV:E) were observed between CRLM and HCC. Significantly lower R(AZV:E) was found for Emprint devices compared to Neuwave; however, reflected energy due to cable and antenna design remains unclear and might contribute to these differences.
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13
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Bellini MI, Urciuoli I, Del Gaudio G, Polti G, Iannetti G, Gangitano E, Lori E, Lubrano C, Cantisani V, Sorrenti S, D’Andrea V. Nonalcoholic fatty liver disease and diabetes. World J Diabetes 2022; 13:668-682. [PMID: 36188142 PMCID: PMC9521438 DOI: 10.4239/wjd.v13.i9.668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/03/2022] [Accepted: 08/06/2022] [Indexed: 02/05/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in the world and represents a clinical-histopathologic entity where the steatosis component may vary in degree and may or may not have fibrotic progression. The key concept of NAFLD pathogenesis is excessive triglyceride hepatic accumulation because of an imbalance between free fatty acid influx and efflux. Strong epidemiological, biochemical, and therapeutic evidence supports the premise that the primary pathophysiological derangement in most patients with NAFLD is insulin resistance; thus the association between diabetes and NAFLD is widely recognized in the literature. Since NAFLD is the hepatic manifestation of a metabolic disease, it is also associated with a higher cardio-vascular risk. Conventional B-mode ultrasound is widely adopted as a first-line imaging modality for hepatic steatosis, although magnetic resonance imaging represents the gold standard noninvasive modality for quantifying the amount of fat in these patients. Treatment of NAFLD patients depends on the disease severity, ranging from a more benign condition of nonalcoholic fatty liver to nonalcoholic steatohepatitis. Abstinence from alcohol, a Mediterranean diet, and modification of risk factors are recommended for patients suffering from NAFLD to avoid major cardiovascular events, as per all diabetic patients. In addition, weight loss induced by bariatric surgery seems to also be effective in improving liver features, together with the benefits for diabetes control or resolution, dyslipidemia, and hypertension. Finally, liver transplantation represents the ultimate treatment for severe nonalcoholic fatty liver disease and is growing rapidly as a main indication in Western countries. This review offers a comprehensive multidisciplinary approach to NAFLD, highlighting its connection with diabetes.
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Affiliation(s)
- Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Irene Urciuoli
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome 00161, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome 00161, Italy
| | - Giovanni Iannetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome 00161, Italy
| | - Elena Gangitano
- Department of Experimental Medicine, Section of Medical Physiopathology, Food Science and Endocrinology, Sapienza University of Rome, Rome 00161, Italy
| | - Eleonora Lori
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Section of Medical Physiopathology, Food Science and Endocrinology, Sapienza University of Rome, Rome 00161, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome 00161, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome 00161, Italy
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14
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Iodine Images in Dual-energy CT: Detection of Hepatic Steatosis by Quantitative Iodine Concentration Values. J Digit Imaging 2022; 35:1738-1747. [PMID: 35879495 DOI: 10.1007/s10278-022-00682-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022] Open
Abstract
Hepatic steatosis is a common condition and an early manifestation of a systemic metabolic syndrome. As of today, there is no broadly accepted method for the diagnosis of hepatic steatosis in contrast-enhanced CT images. This retrospective study evaluates the potential of quantitative iodine values in portal venous phase iodine images in dual-energy CT (DECT) by measuring iodine concentrations in regions of interest (ROI) and analyzing the absolute iodine concentration of the liver parenchyma as well as three different blood-normalized iodine concentrations in a study cohort of 251 patients. An independent two sample t-test (p < 0.05) was used to compare the iodine concentrations of healthy and fatty liver. Diagnostic performance was assessed by ROC (receiver operating characteristic) curve analysis. The results showed significant differences between the average iodine concentration of healthy and fatty liver parenchyma for the absolute and for the blood-normalized iodine concentrations. The study concludes that the iodine uptake of the liver parenchyma is impaired by hepatic steatosis, and that the measurement of iodine concentration can provide a suitable method for the detection of hepatic steatosis in quantitative iodine images. Suitable thresholds of quantitative iodine concentration values for the diagnosis of hepatic steatosis are provided.
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15
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Detection of fatty liver using virtual non-contrast dual-energy CT. Abdom Radiol (NY) 2022; 47:2046-2056. [PMID: 35306577 PMCID: PMC9107401 DOI: 10.1007/s00261-022-03482-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Determine whether liver attenuation measured on dual-energy CT (DECT) virtual non-contrast examinations predicts the presence of fatty liver. METHODS Single-institution retrospective review from 2016 to 2020 found patients with DECT and proton density fat fraction MRI (MRI PDFF) within 30 days. MRI PDFF was the reference standard for determining hepatic steatosis. Attenuation measurements from VNC and mixed 120 kVp-like images were compared to MRI PDFF in the right and left lobes. Performance of VNC was compared to measurement of the liver-spleen attenuation difference (LSAD). RESULTS 128 patients were included (69 men, 59 women) with mean age 51.6 years (range 14-98 years). > 90% of patients received CT and MRI in the emergency department or as inpatients. Median interval between DECT and MRI PDFF was 2 days (range 0-28 days). Prevalence of fatty liver using the reference standard (MRI PDFF > 6%) was 24%. Pearson correlation coefficient between VNC and MRI- DFF was -0.64 (right) and -0.68 (left, both p < 0.0001). For LSAD, correlation was - 0.43 in both lobes (p < 0.0001). Considering MRI PDFF > 6% as diagnostic of steatosis, area under the receiver operator characteristic curve (AUC) was 0.834 and 0.872 in the right and left hepatic lobes, with an optimal threshold of 54.8 HU (right) and 52.5 HU (left), yielding sensitivity/specificity of 57%/93.9% (right) and 67.9%/90% (left). For LSAD, AUC was 0.808 (right) and 0.767 (left) with optimal sensitivity/specificity of 93.3%/57.1% (right) and 78.6%/68% (left). CONCLUSION Attenuation measured at VNC CT was moderately correlated with liver fat content and had > 90% specificity for diagnosis of fatty liver.
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16
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Doğan E, Bacaksızlar Sarı F. Is Fat Deposition of Renal Sinus a Concomitant Finding to Fatty Liver Disease? The First Study Regarding the Relationship Between Kidney and Liver Fat Content with Non-Contrast Computed Tomography. Spartan Med Res J 2022; 7:32411. [PMID: 35291709 PMCID: PMC8873428 DOI: 10.51894/001c.32411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It has been established that abnormal fat deposits are associated with fat deposition in other abdominal regions and linked to obesity, diabetes mellitus, hypertension, vascular and metabolic diseases. This study aimed to determine whether there was a relationship between fat deposition of the renal (i.e., kidney) sinus (FRS) and fatty liver disease (FLD) in a sample of adults. The authors hypothesized that FRS could be a diagnostic finding associated with Hepatosteatosis (HS) in a sample of younger patients. This study was the first apparent investigation of this possible phenomenon. METHODS A convenience sample of 92 adult patients of which 19 (20.7%) were females and 73 (79.3%) were males, and with a mean age of 30.19 (SD = 6.00) were included. The authors calculated Hounsfield Units (HU) (i.e., relative quantitative measurement of radio density) of patients' livers and spleens on non-contrast computed tomography (CT). Liver and spleen differences < 10 HU were considered steatosis (FLD). The authors stratified sample patients into two analytic subgroups according to the presence of FLD or not and compared them based on their FRS widths. RESULTS In the FLD subgroup (N = 48), the difference of HU values between liver and spleen was -5.19 (SD = 11.32), with a range of -38 - 8 HU, while, in the non-steatosis subgroup (N = 44), the mean difference was 16.36 (SD = 3.90), range of 11 - 26 HU. The average diameter of FRS width was 12.5 mm in those patients with steatosis (FLD subgroup) although 9.3 mm in non-FLD patients. (p = 0.02). CONCLUSIONS Based on these results, FRS may be able to be used by radiologists as an ancillary method in the detection of hepatic steatosis in younger adults. The effectiveness of premedical processes (e.g., exercise and diet modification) can also be increased by non-radiologists after detection of lower-grade HS.
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17
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Chung J, Park HS, Kim YJ, Yu MH, Park S, Jung SI. Association of Hepatic Steatosis Index with Nonalcoholic Fatty Liver Disease Diagnosed by Non-Enhanced CT in a Screening Population. Diagnostics (Basel) 2021; 11:diagnostics11122168. [PMID: 34943405 PMCID: PMC8700546 DOI: 10.3390/diagnostics11122168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022] Open
Abstract
The noninvasive diagnosis of hepatic steatosis is of increasing concern. This study investigated the association of hepatic steatosis determined by non-enhanced CT criteria with clinical parameters in a screening population. Asymptomatic patients who underwent abdominal CT at our healthcare center were retrospectively analyzed (n = 339). Two radiologists measured the attenuation values of the liver parenchyma and spleen using non-enhanced CT images. CT criteria for hepatic steatosis were (a) absolute liver attenuation value <48 Hounsfield units (HU), (b) liver-to-spleen attenuation ratio <0.8, and (c) attenuation difference between the liver and spleen <-10. Body mass index (BMI) and hepatic steatosis index (HSI) were calculated, and laboratory findings were recorded. The association of hepatic steatosis with clinical parameters was assessed using univariate and logistic regression analyses. The presence of hepatic steatosis was significantly associated with the levels of serum fasting glucose and triglycerides, the alanine aminotransferase to aspartate aminotransferase (ALT/AST) ratio, BMI, and HSI values using any of the CT criteria. Logistic regression analysis revealed that the serum fasting glucose level and HSI were significantly associated with hepatic steatosis using criterion (a), while the ALT/AST ratio and HSI were associated with hepatic steatosis using criteria (b) and (c). The presence of hepatic steatosis on non-enhanced CT should be considered to indicate possible clinical profile abnormalities regarding metabolic syndrome.
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Affiliation(s)
| | - Hee-Sun Park
- Correspondence: ; Tel.: +82-2-2030-5497; Fax: +82-2-2030-7748
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Starekova J, Hernando D, Pickhardt PJ, Reeder SB. Quantification of Liver Fat Content with CT and MRI: State of the Art. Radiology 2021; 301:250-262. [PMID: 34546125 PMCID: PMC8574059 DOI: 10.1148/radiol.2021204288] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
Hepatic steatosis is defined as pathologically elevated liver fat content and has many underlying causes. Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with an increasing prevalence among adults and children. Abnormal liver fat accumulation has serious consequences, including cirrhosis, liver failure, and hepatocellular carcinoma. In addition, hepatic steatosis is increasingly recognized as an independent risk factor for the metabolic syndrome, type 2 diabetes, and, most important, cardiovascular mortality. During the past 2 decades, noninvasive imaging-based methods for the evaluation of hepatic steatosis have been developed and disseminated. Chemical shift-encoded MRI is now established as the most accurate and precise method for liver fat quantification. CT is important for the detection and quantification of incidental steatosis and may play an increasingly prominent role in risk stratification, particularly with the emergence of CT-based screening and artificial intelligence. Quantitative imaging methods are increasingly used for diagnostic work-up and management of steatosis, including treatment monitoring. The purpose of this state-of-the-art review is to provide an overview of recent progress and current state of the art for liver fat quantification using CT and MRI, as well as important practical considerations related to clinical implementation.
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Affiliation(s)
- Jitka Starekova
- From the Departments of Radiology (J.S., D.H., P.J.P., S.B.R.),
Medical Physics (D.H., S.B.R.), Biomedical Engineering (S.B.R.), Medicine
(S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 1111
Highland Ave, Madison, WI 53705
| | - Diego Hernando
- From the Departments of Radiology (J.S., D.H., P.J.P., S.B.R.),
Medical Physics (D.H., S.B.R.), Biomedical Engineering (S.B.R.), Medicine
(S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 1111
Highland Ave, Madison, WI 53705
| | - Perry J. Pickhardt
- From the Departments of Radiology (J.S., D.H., P.J.P., S.B.R.),
Medical Physics (D.H., S.B.R.), Biomedical Engineering (S.B.R.), Medicine
(S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 1111
Highland Ave, Madison, WI 53705
| | - Scott B. Reeder
- From the Departments of Radiology (J.S., D.H., P.J.P., S.B.R.),
Medical Physics (D.H., S.B.R.), Biomedical Engineering (S.B.R.), Medicine
(S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 1111
Highland Ave, Madison, WI 53705
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A Metric for Quantification of Iodine Contrast Enhancement (Q-ICE) in Computed Tomography. J Comput Assist Tomogr 2021; 45:870-876. [PMID: 34469906 DOI: 10.1097/rct.0000000000001215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Poor contrast enhancement is related to issues with examination execution, contrast prescription, computed tomography (CT) protocols, and patient conditions. Currently, our community has no metric to monitor true enhancement on routine single-phase examinations because this requires knowledge of both pre- and postcontrast CT number. PURPOSE We propose an automatable solution to quantifying contrast enhancement without requiring a dedicated noncontrast series. METHODS The difference in CT number between a target region in an enhanced and unenhanced image defines the metric "quantification of iodine contrast enhancement" (Q-ICE). Quantification of iodine contrast enhancement uses the noncontrast bolus tracking baseline image from routine abdominal examinations, which mitigates the need for a dedicated noncontrast series. We applied this method retrospectively to 312 patient livers from 2 sites between 2017 and 2020. Each site used a weight-based contrast injection protocol for weights 60 to 113 kg and a constant volume less than 60 kg and greater than 113 kg. Hypothesis testing was performed to compare Q-ICE between sites and detect Q-ICE dependence on weight and kilovoltage (kV). RESULTS Mean Q-ICE differed between sites (P = 0.004) by 4.96 Hounsfield unit with 95% confidence interval (1.63-8.28), albeit this difference was roughly 2 times smaller than the SD in Q-ICE across patients at a single site. For patients between 60 and 113 kg, we did not observe evidence of Q-ICE varying with patient weight (P = 0.920 and 0.064 for 120 and 140 kV, respectively). The Q-ICE did vary with patient weight for patients less than 60 kg (P = 0.003) and greater than 113 kg (P = 0.04). We observed a roughly 10 Hounsfield unit reduction in Q-ICE liver for patients scanned with 140 versus 120 kV. We observed several underenhancing examinations with an arterial phase appearance motivating our CT protocol optimization team to consider increasing the delay for slowly enhancing patients. CONCLUSIONS A quality metric for quantifying CT contrast enhancement was developed and suggested tangible opportunities for quality improvement and potential financial savings.
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Heseltine T, Murray S, Ortega-Martorell S, Olier I, Lip GYH, Khoo S. Associations of Hepatosteatosis With Cardiovascular Disease in HIV-Positive and HIV-Negative Patients: The Liverpool HIV-Heart Project. J Acquir Immune Defic Syndr 2021; 87:1221-1227. [PMID: 33990492 DOI: 10.1097/qai.0000000000002721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatosteatosis (HS) has been associated with cardiovascular disorders in the general population. We sought to investigate whether HS is a marker of cardiovascular disease (CVD) risk in HIV-positive individuals, given that metabolic syndrome is implicated in the increasing CVD burden in this population. AIMS To investigate the association of HS with CVD in HIV-positive and HIV-negative individuals. METHODS AND RESULTS We analyzed computed tomography (CT) images of 1306 subjects of whom 209 (16%) were HIV-positive and 1097 (84%) HIV-negative. CVD was quantified by the presence of coronary calcification from both dedicated cardiac CT and nondedicated thorax CT. HS was diagnosed from CT data sets in those with noncontrast dedicated cardiac CT and those with venous phase liver CT using previously validated techniques. Previous liver ultrasound was also assessed for the presence of HS. The HIV-positive group had lower mean age (P < 0.005), higher proportions of male sex (P < 0.005), and more current smokers (P < 0.005). The HIV-negative group had higher proportions of hypertension (P < 0.005), type II diabetes (P = 0.032), dyslipidemia (P < 0.005), statin use (P = 0.008), and HS (P = 0.018). The prevalence of coronary calcification was not significantly different between the groups. Logistic regression (LR) demonstrated that in the HIV-positive group, increasing age [odds ratio (OR): 1.15, P < 0.005], male sex (OR 3.37, P = 0.022), and HS (OR 3.13, P = 0.005) were independently associated with CVD. In the HIV-negative group, increasing age (OR: 1.11, P < 0.005), male sex (OR 2.97, P < 0.005), current smoking (OR 1.96, P < 0.005), and dyslipidemia (OR 1.66, P = 0.03) were independently associated with CVD. Using a machine learning random forest algorithm to assess the variables of importance, the top 3 variables of importance in the HIV-positive group were age, HS, and male sex. In the HIV-negative group, the top 3 variables were age, hypertension and male sex. The LR models predicted CVD well, with the mean area under the receiver operator curve (AUC) for the HIV-positive and HIV-negative cohorts being 0.831 [95% confidence interval (CI): 0.713 to 0.928] and 0.786 (95% CI: 0.735 to 0.836), respectively. The random forest models outperformed LR models, with a mean AUC in HIV-positive and HIV-negative populations of 0.877 (95% CI: 0.775 to 0.959) and 0.828 (95% CI: 0.780 to 0.873) respectively, with differences between both methods being statistically significant. CONCLUSION In contrast to the general population, HS is a strong and independent predictor of CVD in HIV-positive individuals. This suggests that metabolic dysfunction may be attributable to the excess CVD risk seen with these patient groups. Assessment of HS may help accurate quantification of CVD risk in HIV-positive patients.
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Affiliation(s)
- Thomas Heseltine
- Department of Cardiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
| | - Scott Murray
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
| | - Saye Khoo
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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21
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McNelis K, Yodoshi T, Divanovic S, Gandhi C, Kim JH, Anton CG, Trout AT, Mouzaki M. Hepatic Steatosis in Infancy: The Beginning of Pediatric Nonalcoholic Fatty Liver Disease? JPGN REPORTS 2021; 2:e113. [PMID: 37205943 PMCID: PMC10191463 DOI: 10.1097/pg9.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/02/2021] [Indexed: 05/21/2023]
Abstract
UNLABELLED Nonalcoholic fatty liver disease is clinically silent and the age of its onset is unknown. Fatty liver can occur as early as in utero in the context of an unfavorable maternal metabolic environment. Our objective was to determine the prevalence of hepatic steatosis in a cohort of previously healthy infants less than 3 months of age. METHODS Retrospective study of all abdominal computed tomography (CT) scans performed from 2009 to 2019 for the investigation of trauma. Two independent reviewers applied published criteria to determine the presence of hepatic steatosis. Descriptive statistics were used. The groups with and without steatosis were compared using Wilcoxon-Mann Whitney or Fisher exact test. RESULTS Of 119 CT scans available in infants younger than 3 months of age, 65 were performed in previously healthy infants for the investigation of trauma. The included population was predominantly male, non-Hispanic, with a median age of 60 days (interquartile range, 34-73 d). Depending on the criteria used, 23% or 26% of infants had evidence of fatty liver. The prevalence of maternal obesity and/or diabetes was 11% (of the 65 pregnancies) but there was no significant difference in maternal risk factors between infants with and without evidence of steatosis. CONCLUSIONS Findings suggest CT evidence of hepatic steatosis in up to a quarter of otherwise healthy infants ≤3 months of age. This may represent early manifestation of pediatric nonalcoholic fatty liver disease. The natural history and pathophysiology of this condition need to be studied to determine optimal detection, prevention and early intervention strategies.
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Affiliation(s)
- Kera McNelis
- From the Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Toshifumi Yodoshi
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Okinawa Chubu Hospital, Okinawa, Japan
| | - Senad Divanovic
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chandrashekhar Gandhi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jae H. Kim
- From the Division of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher G. Anton
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Marialena Mouzaki
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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22
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Pickhardt PJ, Blake GM, Graffy PM, Sandfort V, Elton DC, Perez AA, Summers RM. Liver Steatosis Categorization on Contrast-Enhanced CT Using a Fully Automated Deep Learning Volumetric Segmentation Tool: Evaluation in 1204 Healthy Adults Using Unenhanced CT as a Reference Standard. AJR Am J Roentgenol 2021; 217:359-367. [PMID: 32936018 DOI: 10.2214/ajr.20.24415] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Hepatic attenuation at unenhanced CT is linearly correlated with the MRI proton density fat fraction (PDFF). Liver fat quantification at contrast-enhanced CT is more challenging. OBJECTIVE. The purpose of this article is to evaluate liver steatosis categorization on contrast-enhanced CT using a fully automated deep learning volumetric hepatosplenic segmentation algorithm and unenhanced CT as the reference standard. METHODS. A fully automated volumetric hepatosplenic segmentation algorithm using 3D convolutional neural networks was applied to unenhanced and contrast-enhanced series from a sample of 1204 healthy adults (mean age, 45.2 years; 726 women, 478 men) undergoing CT evaluation for renal donation. The mean volumetric attenuation was computed from all designated liver and spleen voxels. PDFF was estimated from unenhanced CT attenuation and served as the reference standard. Contrast-enhanced attenuations were evaluated for detecting PDFF thresholds of 5% (mild steatosis, 10% and 15% (moderate steatosis); PDFF less than 5% was considered normal. RESULTS. Using unenhanced CT as reference, estimated PDFF was ≥ 5% (mild steatosis), ≥ 10%, and ≥ 15% (moderate steatosis) in 50.1% (n = 603), 12.5% (n = 151) and 4.8% (n = 58) of patients, respectively. ROC AUC values for predicting PDFF thresholds of 5%, 10%, and 15% using contrast-enhanced liver attenuation were 0.669, 0.854, and 0.962, respectively, and using contrast-enhanced liver-spleen attenuation difference were 0.662, 0.866, and 0.986, respectively. A total of 96.8% (90/93) of patients with contrast-enhanced liver attenuation less than 90 HU had steatosis (PDFF ≥ 5%); this threshold of less than 90 HU achieved sensitivity of 75.9% and specificity of 95.7% for moderate steatosis (PDFF ≥ 15%). Liver attenuation less than 100 HU achieved sensitivity of 34.0% and specificity of 94.2% for any steatosis (PDFF ≥ 5%). A total of 93.8% (30/32) of patients with contrast-enhanced liver-spleen attenuation difference 10 HU or less had moderate steatosis (PDFF ≥ 15%); a liver-spleen difference less than 5 HU achieved sensitivity of 91.4% and specificity of 95.0% for moderate steatosis. Liver-spleen difference less than 10 HU achieved sensitivity of 29.5% and specificity of 95.5% for any steatosis (PDFF ≥ 5%). CONCLUSION. Contrast-enhanced volumetric hepatosplenic attenuation derived using a fully automated deep learning CT tool may allow objective categoric assessment of hepatic steatosis. Accuracy was better for moderate than mild steatosis. Further confirmation using different scanning protocols and vendors is warranted. CLINICAL IMPACT. If these results are confirmed in independent patient samples, this automated approach could prove useful for both individualized and population-based steatosis assessment.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, The University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Glen M Blake
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Peter M Graffy
- Department of Radiology, The University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Veit Sandfort
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD
| | - Daniel C Elton
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD
| | - Alberto A Perez
- Department of Radiology, The University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD
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Pickhardt PJ, Graffy PM, Perez AA, Lubner MG, Elton DC, Summers RM. Opportunistic Screening at Abdominal CT: Use of Automated Body Composition Biomarkers for Added Cardiometabolic Value. Radiographics 2021; 41:524-542. [PMID: 33646902 DOI: 10.1148/rg.2021200056] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal CT is a frequently performed imaging examination for a wide variety of clinical indications. In addition to the immediate reason for scanning, each CT examination contains robust additional data on body composition that generally go unused in routine clinical practice. There is now growing interest in harnessing this additional information. Prime examples of cardiometabolic information include measurement of bone mineral density for osteoporosis screening, quantification of aortic calcium for assessment of cardiovascular risk, quantification of visceral fat for evaluation of metabolic syndrome, assessment of muscle bulk and density for diagnosis of sarcopenia, and quantification of liver fat for assessment of hepatic steatosis. All of these relevant biometric measures can now be fully automated through the use of artificial intelligence algorithms, which provide rapid and objective assessment and allow large-scale population-based screening. Initial investigations into these measures of body composition have demonstrated promising performance for prediction of future adverse events that matches or exceeds the best available clinical prediction models, particularly when these CT-based measures are used in combination. In this review, the concept of CT-based opportunistic screening is discussed, and an overview of the various automated biomarkers that can be derived from essentially all abdominal CT examinations is provided, drawing heavily on the authors' experience. As radiology transitions from a volume-based to a value-based practice, opportunistic screening represents a promising example of adding value to services that are already provided. If the potentially high added value of these objective CT-based automated measures is ultimately confirmed in subsequent investigations, this opportunistic screening approach could be considered for intentional CT-based screening. ©RSNA, 2021.
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Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Peter M Graffy
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Alberto A Perez
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Daniel C Elton
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
| | - Ronald M Summers
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252 (P.J.P., P.M.G., A.A.P., M.G.L.); and Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (D.C.E., R.M.S.)
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24
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Anderson MA, Kordbacheh H, Joseph E, Bennett SE, Stanford FC, Kambadakone A. Computed tomography findings of metabolic syndrome in patients with acute colonic diverticulitis. J Med Imaging Radiat Oncol 2021; 65:279-285. [PMID: 33591625 DOI: 10.1111/1754-9485.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many factors associated with colonic diverticulitis are also part of the clinical definition of the metabolic syndrome. Computed tomography (CT) is commonly performed in symptomatic patients, such as those with suspected or known acute diverticulitis, and could add additional value for the health of these patients by identifying and reporting CT biomarkers of metabolic syndrome, if present and detectable. The purpose of this study was to identify CT biomarkers of metabolic syndrome in patients with acute colonic diverticulitis. METHODS We retrospectively reviewed 243 patients (mean-60 yrs, M:F:126:117) diagnosed with colonic diverticulitis on CT between March 2015 and March 2017 for hepatic steatosis, vascular calcifications, abdominal diameters and fat volumes. Criteria of metabolic syndrome were obtained from medical records. Differences in imaging biomarkers were compared using chi-square comparisons stratified by metabolic syndrome, abdominal diameter and fat volume. RESULTS Of 243 patients, 33% demonstrated hepatic steatosis and 71% atherosclerotic vascular calcifications on CT. 28% met criteria for metabolic syndrome. Patients with metabolic syndrome had higher occurrence of hepatic steatosis, sagittal diameter ≥ 35 cm, visceral fat > 5000 cm3 and subcutaneous fat > 8300 cm3 (P < 0.05), but not vascular calcifications (P > 0.05). CONCLUSIONS CT biomarkers of metabolic syndrome are commonly encountered in patients with acute diverticulitis. Recognizing and reporting these findings can guide towards further evaluation for metabolic syndrome.
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Affiliation(s)
- Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Hamed Kordbacheh
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Evita Joseph
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Susan E Bennett
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine- Neuroendocrine Units, Department of Pediatrics- Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Abstract
OBJECTIVE. The purpose of this study was to evaluate the utility of laboratory and CT metrics in identifying patients with high-risk nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS. Patients with biopsy-proven NAFLD who underwent CT within 1 year of biopsy were included. Histopathologic review was performed by an experienced gastrointestinal pathologist to determine steatosis, inflammation, and fibrosis. The presence of any lobular inflammation and hepatocyte ballooning was categorized as nonalcoholic steatohepatitis (NASH). Patients with NAFLD and advanced fibrosis (stage F3 or higher) were categorized as having high-risk NAFLD. Aspartate transaminase to platelet ratio index and Fibrosis-4 (FIB-4) laboratory scores were calculated. CT metrics included hepatic attenuation, liver segmental volume ratio (LSVR), splenic volume, liver surface nodularity score, and selected texture features. In addition, two readers subjectively assessed the presence of NASH (present or not present) and fibrosis (stages F0-F4). RESULTS. A total of 186 patients with NAFLD (mean age, 49 years; 74 men and 112 women) were included. Of these, 87 (47%) had NASH and 112 (60%) had moderate to severe steatosis. A total of 51 patients were classified as fibrosis stage F0, 42 as F1, 23 as F2, 37 as F3, and 33 as F4. Additionally, 70 (38%) had advanced fibrosis (stage F3 or F4) and were considered to have high-risk NAFLD. FIB-4 score correlated with fibrosis (ROC AUC of 0.75 for identifying high-risk NAFLD). Of the individual CT parameters, LSVR and splenic volume performed best (AUC of 0.69 for both for detecting high-risk NAFLD). Subjective reader assessment performed best among all parameters (AUCs of 0.78 for reader 1 and 0.79 for reader 2 for detecting high-risk NAFLD). FIB-4 and subjective scores were complementary (combined AUC of 0.82 for detecting high-risk NAFLD). For NASH assessment, FIB-4 performed best (AUC of 0.68), whereas the AUCs were less than 0.60 for all individual CT features and subjective assessments. CONCLUSION. FIB-4 and multiple CT findings can identify patients with high-risk NAFLD (advanced fibrosis or cirrhosis). However, the presence of NASH is elusive on CT.
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Miele L, Zocco MA, Pizzolante F, De Matthaeis N, Ainora ME, Liguori A, Gasbarrini A, Grieco A, Rapaccini G. Use of imaging techniques for non-invasive assessment in the diagnosis and staging of non-alcoholic fatty liver disease. Metabolism 2020; 112:154355. [PMID: 32916154 DOI: 10.1016/j.metabol.2020.154355] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and represent a common finding in highly prevalent metabolic disorders (i.e. type 2 diabetes, metabolic syndrome, obesity). Non-alcoholic steatohepatitis (NASH) requires liver biopsy for grading and staging the liver damage by the assessment of steatosis, inflammation and fibrosis. In parallel with the development of numerous 'liquid' biomarkers and algorithms that combine anthropometric and laboratory parameters, innovative hepatic imaging techniques have increasingly been developed to attempt to overcome the need for biopsy, both in diagnosis and staging of NAFLD, and in possible use in the follow-up of the disease. In this review, we focused on the different imaging techniques trying to highlight the strengths and disadvantages of different approaches, particularly for ultrasound techniques, in stratifying liver injury and fibrosis in patients with NAFLD / NASH.
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Affiliation(s)
- Luca Miele
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy.
| | - Maria A Zocco
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Fabrizio Pizzolante
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Nicoletta De Matthaeis
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Maria E Ainora
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Antonio Liguori
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Antonio Grieco
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Gianludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
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Flick KF, Al-Temimi MH, Maatman TK, Sublette CM, Swensson JK, Nakeeb A, Ceppa EP, Nguyen TK, Schmidt CM, Zyromski NJ, Tann MA, House MG. Hepatic Steatosis After Neoadjuvant Chemotherapy for Pancreatic Cancer: Incidence and Implications for Outcomes After Pancreatoduodenectomy. J Gastrointest Surg 2020; 24:2008-2014. [PMID: 32671796 PMCID: PMC7363010 DOI: 10.1007/s11605-020-04723-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study aimed to determine the incidence of new onset hepatic steatosis after neoadjuvant chemotherapy for pancreatic cancer and its impact on outcomes after pancreatoduodenectomy. METHODS Retrospective review identified patients who received neoadjuvant chemotherapy for pancreatic adenocarcinoma and underwent pancreatoduodenectomy from 2013 to 2018. Preoperative computed tomography scans were evaluated for the development of hepatic steatosis after neoadjuvant chemotherapy. Hypoattenuation included liver attenuation greater than or equal to 10 Hounsfield units less than tissue density of spleen on noncontrast computed tomography and greater than or equal to 20 Hounsfield units less on contrast-enhanced computed tomography. RESULTS One hundred forty-nine patients received neoadjuvant chemotherapy for a median of 5 cycles (interquartile range (IQR), 4-6). FOLFIRINOX was the regimen in 78% of patients. Hepatic steatosis developed in 36 (24%) patients. The median time from neoadjuvant chemotherapy completion to pancreatoduodenectomy was 40 days (IQR, 29-51). Preoperative biliary stenting was performed in 126 (86%) patients. Neoadjuvant radiotherapy was delivered to 23 (15%) patients. Female gender, obesity, and prolonged exposure to chemotherapy were identified as risk factors for chemotherapy-associated hepatic steatosis. Compared with control patients without neoadjuvant chemotherapy-associated hepatic steatosis, patients developing steatosis had similar rates of postoperative pancreatic fistula (8% (control) vs. 4%, p = 0.3), delayed gastric emptying (8% vs. 14%, p = 0.4), and major morbidity (11% vs. 15%, p = 0.6). Ninety-day mortality was similar between groups (8% vs. 2%, p = 0.08). CONCLUSION Hepatic steatosis developed in 24% of patients who received neoadjuvant chemotherapy but was not associated with increased morbidity or mortality after pancreatoduodenectomy.
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Affiliation(s)
- K. F. Flick
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - M. H. Al-Temimi
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - T. K. Maatman
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - C. M. Sublette
- Indiana University School of Medicine, Indianapolis, IN USA
| | - J. K. Swensson
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - A. Nakeeb
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - E. P. Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - T. K. Nguyen
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - C. M. Schmidt
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - N. J. Zyromski
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
| | - M. A. Tann
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - M. G. House
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 515, Indianapolis, IN 46202 USA
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Şeker M, Erol C, Sevmiş Ş, Saka B, Durur Karakaya A. Comparison of CT methods for determining graft steatosis in living donor liver transplantation. Abdom Radiol (NY) 2019; 44:2418-2429. [PMID: 30937504 DOI: 10.1007/s00261-019-01993-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic performance of non-enhanced computed tomography (NECT) and contrast-enhanced CT (CECT) attenuation indices in the assessment of hepatic steatosis by using biopsy as the reference standard. MATERIALS AND METHODS This retrospective study was approved by our Institutional Review Board. 55 Potential donors who underwent both NECT and triphasic CECT and core liver biopsy, were included the study. Average attenuation measurements that were obtained from multiple regions in liver, spleen, and psoas muscle on both unenhanced and CECT were used for analysis. Hepatic attenuation measurements were analyzed with and without normalization with the spleen and psoas muscle. Linear regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the statistical association between CT indices and steatosis at histology. RESULTS Linear regression analysis confirmed the strongest correlation between steatosis and normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT scan (R 0.821; R2 0.674 and R 0.816; R2 0.665, respectively). The use of ROC curve analysis also demonstrated that normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT showed high diagnostic performance regarding the qualitative distinction of steatosis (AUC values greater than 0.9). CONCLUSION Attenuation measurements of liver normalized with spleen on hepatic venous phase may be useful in evaluating steatosis in donor candidates with moderate to severe steatosis who are unacceptable for liver donation. In this manner unnecessary liver biopsy may be avoided in those donor candidates.
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Affiliation(s)
- Mehmet Şeker
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey.
| | - Cengiz Erol
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
| | - Şinasi Sevmiş
- Department of Surgery, Yeni Yuzyıl University, Gaziosmanpaşa, 34245, Istanbul, Turkey
| | - Burcu Saka
- Department of Pathology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
| | - Afak Durur Karakaya
- Department of Radiology, Faculty of Medicine, Medipol University, Bağcılar, 34214, Istanbul, Turkey
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Metin NO, Karaosmanoğlu AD, Metin Y, Karçaaltıncaba M. Focal hypersteatosis: a pseudolesion in patients with liver steatosis. ACTA ACUST UNITED AC 2019; 25:14-20. [PMID: 30582571 DOI: 10.5152/dir.2018.17519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to describe ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) findings of focal hypersteatosis (FHS). METHODS We retrospectively reviewed our database for patients with hypersteatosis. Over a 5-year period (February 2005 to September 2010) a total of 17 321 patients underwent abdominal CT scan and 28 patients were determined to have FHS. All patients had US, CT, and MRI studies. Size, area, and density measurements were performed on CT images. Fat signal percentage (FSP) was measured on T1-weighted in- and out-of-phase gradient-echo images. FHS was defined based on MRI findings, as an area of greater signal drop on out-of phase images compared with the rest of the fatty liver. RESULTS The period prevelance of focal hypersteatosis was measured as 0.16% over the 5-year period. Cancer was the most common diagnosis (22 of 28 patients, 78.5%), with the breast (32.1%) and colorectal (25%) cancers predominating. FHS was seen in segment 4 (n=26, 92.8%), segment 8 (n=1, 3.6%), and segment 3 (n=1, 3.6%). Shape was nodular in 21 patients (75%), while triangular or amorphous in the remaining 7 patients (25%). FHS was hyperechoic and isoechoic in 5 (17.9%) and 23 (82.1%) patients, respectively. FHS was hypodense on CT of all patients relative to fatty liver. On MRI, the FHS was hyperintense on T1-weighted in-phase images in 17 patients (60.7%). Median liver parenchymal FSP was 21.5% (range, 10%-41.4%) and median FSP of hypersteatotic area was 32.5% (range, 19%-45%). CONCLUSION Focal hypersteatosis is a pseudolesion that can be observed in patients with liver steatosis. It appears hypodense on CT and mostly isoechoic on US relative to fatty liver. It may mimic metastasis in cancer patients with steatosis, due to nodular shape and atypical location. MRI should be used for correct diagnosis in patients with equivocal findings on CT to avoid biopsy.
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Affiliation(s)
- Nurgül Orhan Metin
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Yavuz Metin
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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30
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Dhaliwal J, Chavhan GB, Lurz E, Shalabi A, Yuen N, Williams B, Martincevic I, Amirabadi A, Wales PW, Lee W, Ling SC, Mouzaki M. Hepatic steatosis is highly prevalent across the paediatric age spectrum, including in pre-school age children. Aliment Pharmacol Ther 2018; 48:556-563. [PMID: 29998462 DOI: 10.1111/apt.14900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/21/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevalence of non-alcoholic fatty liver disease (NAFLD) in children is 8% in the general population, and 34% in the context of obesity. There is a paucity of data on the prevalence of hepatic steatosis in healthy children in Ontario. AIMS To determine the prevalence of hepatic steatosis using abdominal computed tomography (CT) scans in a cohort of previously healthy children across the paediatric age spectrum in Ontario, Canada, and to determine any association between measures of abdominal adiposity and hepatic steatosis. METHODS Retrospective review of the SickKids Trauma Database from 2004-2015. Previously healthy children ages 1-17 years having undergone an abdominal CT scan as a part of routine trauma assessment were included, and those with an intra-abdominal injury excluded. Steatosis was defined as a difference between liver and spleen attenuation ≤-25HU. The percentage of the total area occupied by abdominal subcutaneous adipose and visceral adipose tissue was measured. Anthropometrics and baseline demographics were collected. RESULTS A total of 503 (51% male) children with mean (±SD) age 9.5 ± 4.5 years and weight z-score of 0.37 ± 1.05 were studied. Seventy-seven (15%, 95% CI [12%-18%]) had hepatic steatosis; no differences found between sexes or across age quartiles. The abdominal subcutaneous adipose tissue area was greater in those with hepatic steatosis compared to those without (32% [22-42] vs 24% [17-36], P = 0.003). The visceral adipose tissue area was significantly greater in older children ≥9.8 years with hepatic steatosis (7.7% [5.1-10] vs 6.6% (4.9-8.5), P = 0.04). CONCLUSION Hepatic steatosis was highly prevalent in previously healthy children in Ontario, including children of pre-school age. We found an association between hepatic steatosis and abdominal subcutaneous adipose tissue, and in older children with visceral adipose tissue.
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Affiliation(s)
- J Dhaliwal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - G B Chavhan
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - E Lurz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - A Shalabi
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - N Yuen
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - B Williams
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - I Martincevic
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - A Amirabadi
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - P W Wales
- The Hospital for Sick Children, Toronto, ON, Canada.,Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - W Lee
- The Hospital for Sick Children, Toronto, ON, Canada.,Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - S C Ling
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - M Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
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31
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Zhang YN, Fowler KJ, Hamilton G, Cui JY, Sy EZ, Balanay M, Hooker JC, Szeverenyi N, Sirlin CB. Liver fat imaging-a clinical overview of ultrasound, CT, and MR imaging. Br J Radiol 2018; 91:20170959. [PMID: 29722568 PMCID: PMC6223150 DOI: 10.1259/bjr.20170959] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic steatosis is a frequently encountered imaging finding that may indicate chronic liver disease, the most common of which is non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is implicated in the development of systemic diseases and its progressive phenotype, non-alcoholic steatohepatitis, leads to increased liver-specific morbidity and mortality. With the rising obesity epidemic and advent of novel therapeutics aimed at altering metabolism, there is a growing need to quantify and monitor liver steatosis. Imaging methods for assessing steatosis range from simple and qualitative to complex and highly accurate metrics. Ultrasound may be appropriate in some clinical instances as a screening modality to identify the presence of abnormal liver morphology. However, it lacks sufficient specificity and sensitivity to constitute a diagnostic modality for instigating and monitoring therapy. Newer ultrasound techniques such as quantitative ultrasound show promise in turning qualitative assessment of steatosis on conventional ultrasound into quantitative measurements. Conventional unenhanced CT is capable of detecting and quantifying moderate to severe steatosis but is inaccurate at diagnosing mild steatosis and involves the use of radiation. Newer CT techniques, like dual energy CT, show potential in expanding the role of CT in quantifying steatosis. MRI proton-density fat fraction is currently the most accurate and precise imaging biomarker to quantify liver steatosis. As such, proton-density fat fraction is the most appropriate noninvasive end point for steatosis reduction in clinical trials and therapy response assessment.
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Affiliation(s)
- Yingzhen N Zhang
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Gavin Hamilton
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Jennifer Y Cui
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Ethan Z Sy
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Michelle Balanay
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Jonathan C Hooker
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Nikolaus Szeverenyi
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
| | - Claude B Sirlin
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA, USA
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Quantification of Liver Fat Content With Unenhanced MDCT: Phantom and Clinical Correlation With MRI Proton Density Fat Fraction. AJR Am J Roentgenol 2018; 211:W151-W157. [PMID: 30016142 DOI: 10.2214/ajr.17.19391] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relation between unenhanced CT liver attenuation values and MRI-derived proton density fat fraction (PDFF) for estimation of liver fat content at CT. MATERIALS AND METHODS A CT-MRI phantom was constructed and imaged containing 12 vials with lipid fractions ranging from 0% to 100%. For the retrospective clinical arm, 221 patients (120 men, 101 women; mean age, 54 years) underwent both unenhanced CT and chemical shift-encoded MRI of the liver between 2007 and 2017. Among these patients, 92 had more than one 120-kV CT scan for comparison. CT attenuation and MRI PDFF were derived with coregistered ROI measurements in the right hepatic lobe. The 120-kV subgroup of CT examinations performed within 1 month of MRI PDFF examinations (n = 72) served as the primary cohort for linear correlation. The effects of different tube voltage settings, time intervals between CT and MRI, and iron overload were assessed. Linear least squares regression analysis was performed. RESULTS Phantom results showed excellent linear fit between CT attenuation and MRI PDFF (r2 = 0.986). In patients, 120-kV CT performed within 1 month of MRI PDFF exhibited strong linear correlation (r2 = 0.828) that closely matched the phantom data, yielding the following clinical CT-MRI conversion formula: MRI PDFF (%) = -0.58 × CT attenuation (HU) + 38.2. Correlation worsened for CT-to-MRI intervals longer than 1 month (r2 = 0.565), and this specific relationship did not apply as well to non-120-kV settings (r2 = 0.554). For patients with multiple scans, correlation progressively worsened over time. CT-based liver fat content was underestimated in several patients with iron overload. CONCLUSION The linear correlation between unenhanced CT attenuation and MRI PDFF allows quantification of liver fat content by means of unenhanced CT in clinical practice. As expected, correlation worsened with increasing CT-MRI time interval, variable tube voltage settings, and iron overload.
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Mackay TM, Genç CG, Takkenberg RB, Besselink MG, Somers I, Nieveen van Dijkum EJM. New onset non-alcoholic fatty liver disease after resection of pancreatic neuroendocrine tumors. J Surg Oncol 2018; 117:1548-1555. [PMID: 29572825 PMCID: PMC6055648 DOI: 10.1002/jso.25051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
Background and Objectives Non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatis (NASH) may occur after pancreatic resection due to exocrine pancreatic insufficiency (EPI). Patients with long‐term survival, such as after pancreatic neuroendocrine tumor (pNET) resection, are at risk of NAFLD/NASH. We aimed to determine the incidence and risk factors for new onset NAFLD/NASH and EPI after pNET resection. Methods Retrospective monocenter cohort study. Patients who underwent pNET resection (1992‐2016) were assessed for new onset NAFLD/NASH and EPI. Postoperative NAFLD/NASH was determined by a blinded abdominal radiologist, who compared pre‐ and postoperative imaging. Results Out of 235 patients with pNET, a total of 112 patients underwent resection and were included with a median follow‐up of 54 months. New onset NAFLD/NASH occurred in 20% and EPI in 49% of patients. Multivariate analysis showed that the only risk factor for new onset NAFLD/NASH was recurrent disease (OR 4.4, 95% CI 1.1‐16.8, P = 0.031), but not EPI (OR 0.94, 95% CI 0.3‐2.8, P = 0.911). The only risk factor for EPI was pancreatoduodenectomy (OR 4.3, 95% CI 1.4‐13.7, P = 0.012). Conclusions New onset NAFLD/NASH is occasionally found after pNET resection, especially in patients with recurrent disease, but is not related to EPI.
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Affiliation(s)
- Tara Michella Mackay
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Cansu Güney Genç
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert Bart Takkenberg
- Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc Gerard Besselink
- Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Inne Somers
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
OBJECTIVE The purpose of this article is to review how fat is detected on imaging and to discuss the differential diagnosis of fat-containing liver lesions. CONCLUSION Fat is a highly useful feature in characterizing liver lesions on imaging. Although a variety of liver lesions can show fat on cross-sectional imaging, the presence of fat usually indicates that the lesion is of hepatocellular origin. Less commonly, nonhepatocellular fatty lesions may be distinguished by ancillary clinical and imaging features.
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35
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Lee DH. Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification. Clin Mol Hepatol 2017; 23:290-301. [PMID: 28994271 PMCID: PMC5760010 DOI: 10.3350/cmh.2017.0042] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/26/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has been an emerging major health problem, and the most common cause of chronic liver disease in Western countries. Traditionally, liver biopsy has been gold standard method for quantification of hepatic steatosis. However, its invasive nature with potential complication as well as measurement variability are major problem. Thus, various imaging studies have been used for evaluation of hepatic steatosis. Ultrasonography provides fairly good accuracy to detect moderate-to-severe degree hepatic steatosis, but limited accuracy for mild steatosis. Operator-dependency and subjective/qualitative nature of examination are another major drawbacks of ultrasonography. Computed tomography can be considered as an unsuitable imaging modality for evaluation of NAFLD due to potential risk of radiation exposure and limited accuracy in detecting mild steatosis. Both magnetic resonance spectroscopy and magnetic resonance imaging using chemical shift technique provide highly accurate and reproducible diagnostic performance for evaluating NAFLD, and therefore, have been used in many clinical trials as a non-invasive reference of standard method.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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36
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Zheng D, Tian W, Zheng Z, Gu J, Guo Z, He X. Accuracy of computed tomography for detecting hepatic steatosis in donors for liver transplantation: A meta-analysis. Clin Transplant 2017; 31. [PMID: 28517493 DOI: 10.1111/ctr.13013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Danping Zheng
- Organ Transplant Center; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology; Guangzhou China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation); Guangzhou China
- Department of Gastroenterology; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
| | - Wenshuo Tian
- Department of Ultrasound; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
| | - Zhouying Zheng
- Organ Transplant Center; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology; Guangzhou China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation); Guangzhou China
| | - Jincui Gu
- Organ Transplant Center; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology; Guangzhou China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation); Guangzhou China
| | - Zhiyong Guo
- Organ Transplant Center; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology; Guangzhou China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation); Guangzhou China
| | - Xiaoshun He
- Organ Transplant Center; The First Affiliated Hospital; Sun Yat-Sen University; Guangzhou China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology; Guangzhou China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation); Guangzhou China
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37
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Kang KA, Jang KM, Kim SH, Kang TW, Cha DI. Risk factor assessment to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography in patients with rectal cancer. Clin Radiol 2017; 72:473-481. [PMID: 28258741 DOI: 10.1016/j.crad.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022]
Abstract
AIM To assess the significant factors on rectal magnetic resonance imaging (MRI) to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography (CT) in patients with rectal cancer. MATERIALS AND METHODS A total of 207 patients with rectal cancer who underwent preoperative contrast-enhanced abdominopelvic CT, and rectal and liver MRI were included. Univariate analysis and multivariate logistic regression were used to evaluate the determining factors for the significance of indeterminate hepatic lesions on CT in patients with rectal cancer. RESULTS Hepatic metastases were diagnosed in 29 (20.9%) of 139 patients who had indeterminate hepatic lesions on preoperative CT obtained for rectal cancer. On univariate analysis, carcinoembryonic antigen level, N stage, mesorectal fascia (MRF) invasion, diameter of superior haemorrhoidal vein, and mesorectal vascular lesion (MVL) grade on rectal MRI (p<0.05) were associated with the possibility of metastasis for indeterminate hepatic lesions on CT. On multivariate analysis, MVL grade and MRF invasion on rectal MRI were independent factors associated with the possibility of metastasis for indeterminate hepatic lesions on CT (p<0.0005 and p=0.0066, respectively). CONCLUSION MVL grade and MRF invasion on rectal MRI are independent factors for estimating hepatic metastasis among indeterminate hepatic lesions on CT in patients with rectal cancer.
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Affiliation(s)
- K A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K M Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.
| | - S H Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - D I Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
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Jehangir M, Nazir R, Jang A, Rana A, Rafique S, Dar FS. Macrovesicular steatosis in living related liver donors: correlation of biopsy findings with CT liver attenuation index and body mass index. Clin Transplant 2016; 30:1016-20. [PMID: 27291347 DOI: 10.1111/ctr.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hepatic steatosis threatens post-transplant graft survival; therefore, pre-operative quantification of steatosis is crucial. Gold standard for evaluation is donor liver biopsy but it is invasive. An alternative non-invasive method is a calculation of CT liver attenuation index. BMI can be an independent factor predicting grade of steatosis but it is necessary to re-define appropriate BMI cut-off points that are specific for Asians. OBJECTIVE To retrospectively analyze CT LAI and BMI for quantitative assessment of macrovesicular steatosis in living related liver donors, using histological analysis as gold standard. MATERIALS AND METHODS A radiologist blinded to histological grading calculated mean CT hepatic attenuation in 48 potential living related liver donors. RESULTS CT-derived LAI correctly predicted steatosis in all except 1 patient. Parametric analysis for CT LAI and BMI showed overall weak positive correlation. No significant association was found between BMI and biopsy findings. CONCLUSION Liver biopsy remains a gold standard for evaluation of steatosis. CT LAI of ≤0 correlates well with significant hepatic steatosis and biopsy may be avoided in such cases. Biopsy may be reserved for patients with CT LAI between 1 and 5. BMI alone is not a good predictor of hepatic steatosis in our study population.
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Affiliation(s)
- Maham Jehangir
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan.
| | - Rashed Nazir
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| | - Aisha Jang
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| | - Atif Rana
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Rafique
- Department of Radiology, Shifa International Hospital, Islamabad, Pakistan
| | - Faisal Saud Dar
- Department of Gastroenterology and Liver Transplant, Shifa International Hospital, Islamabad, Pakistan
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Graffy PM, Pickhardt PJ. Quantification of hepatic and visceral fat by CT and MR imaging: relevance to the obesity epidemic, metabolic syndrome and NAFLD. Br J Radiol 2016; 89:20151024. [PMID: 26876880 PMCID: PMC5258166 DOI: 10.1259/bjr.20151024] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 02/06/2023] Open
Abstract
Trends in obesity have continued to increase in the developed world over the past few decades, along with related conditions such as metabolic syndrome, which is strongly associated with this epidemic. Novel and innovative methods to assess relevant obesity-related biomarkers are needed to determine the clinical significance, allow for surveillance and intervene if appropriate. Aggregations of specific types of fat, specifically hepatic and visceral adiposity, are now known to be correlated with these conditions, and there are a variety of imaging techniques to identify and quantify their distributions and provide diagnostic information. These methods are particularly salient for metabolic syndrome, which is related to both hepatic and visceral adiposity but currently not defined by it. Simpler non-specific fat measurements, such as body weight, abdominal circumference and body mass index are more frequently used but lack the ability to characterize fat location. In addition, non-alcoholic fatty liver disease (NAFLD) is a related condition that carries relevance not only for obesity-related diseases but also for the progression of the liver-specific disease, including non-alcoholic steatohepatitis and cirrhosis, albeit at a much lower frequency. Recent CT and MRI techniques have emerged to potentially optimize diagnosing metabolic syndrome and NAFLD through non-invasive quantification of visceral fat and hepatic steatosis with high accuracy. These imaging modalities should aid us in further understanding the relationship of hepatic and visceral fat to the obesity-related conditions such as metabolic syndrome, NAFLD and cardiovascular disease.
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Affiliation(s)
- Peter M Graffy
- Department of Radiology, University of Wisconsin School of Medicine
& Public Health, Madison, WI
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine
& Public Health, Madison, WI
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Dioguardi Burgio M, Bruno O, Agnello F, Torrisi C, Vernuccio F, Cabibbo G, Soresi M, Petta S, Calamia M, Papia G, Gambino A, Ricceri V, Midiri M, Lagalla R, Brancatelli G. The cheating liver: imaging of focal steatosis and fatty sparing. Expert Rev Gastroenterol Hepatol 2016; 10:671-678. [PMID: 27027652 DOI: 10.1586/17474124.2016.1169919] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Focal steatosis and fatty sparing are a frequent finding in liver imaging, and can mimic solid lesions. Liver regional variations in the degree of fat accumulation can be related to vascular anomalies, metabolic disorders, use of certain drugs or coexistence of hepatic masses. CT and MRI are the modalities of choice for the noninvasive diagnosis of hepatic steatosis. Knowledge of CT and MRI appearance of focal steatosis and fatty sparing is crucial for an accurate diagnosis, and to rule-out other pathologic processes. This paper will review the CT and MRI techniques for the diagnosis of hepatic steatosis and the CT and MRI features of common and uncommon causes of focal steatosis and fatty sparing.
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Affiliation(s)
| | - Onorina Bruno
- b Department of Radiology , Hospital Beaujon , Clichy , France
| | - Francesco Agnello
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Chiara Torrisi
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Federica Vernuccio
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Giuseppe Cabibbo
- c Section of Gastroenterology, Di.Bi.M.I.S ., University of Palermo , Palermo , Italy
| | - Maurizio Soresi
- d Unit of Internal Medicine, Di.Bi.M.I.S ., University of Palermo , Palermo , Italy
| | - Salvatore Petta
- c Section of Gastroenterology, Di.Bi.M.I.S ., University of Palermo , Palermo , Italy
| | - Mauro Calamia
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Giovanni Papia
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Angelo Gambino
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Viola Ricceri
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Massimo Midiri
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
| | - Roberto Lagalla
- a Section of Radiology, Di.Bi.Med. , University of Palermo , Palermo , Italy
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Olefson S, Jackson M, Grand DJ, Charpentier KP, Makwana N, Promrat K. Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique. J Clin Transl Hepatol 2015; 3:246-53. [PMID: 26807379 PMCID: PMC4721891 DOI: 10.14218/jcth.2015.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS While traditional risk factors for the development of nonalcoholic fatty liver disease (NAFLD) relate to metabolic syndrome, several Asian studies have suggested a high rate of de novo NAFLD following pancreaticoduodenectomy (PD). The aim of this study is to identify de novo NAFLD after pancreatic surgery and its associated risk factors. METHODS A retrospective cohort of patients at a single center that underwent PD or distal pancreatectomy (DP) over 7 years was identified. Pre- and postoperative contrast-enhanced computed tomography scans of the abdomen were reviewed, including attenuation measurements of the liver, spleen, and muscle. Primary outcomes included hepatic attenuation, liver to muscle ratio (LMR), and liver to spleen ratio (LSR). RESULTS Of the 96 patients (mean age 64.3) included, 70% underwent PD, and 30% underwent DP. The mean LMR decreased significantly from 1.81 to 1.66 (p=0.02), noted only in men. No interaction effect with LMR was observed with surgical type, chemotherapy, blood loss, pancreatic enzyme replacement, or transaminases. LMR decreased in 55% of subjects. CONCLUSIONS Increased fatty infiltration, as evidence by decreased LMR, was found among men that underwent PD and DP within a year of surgery. This may be related to weight loss and malabsorption and deserves further investigation.
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Affiliation(s)
- Sidney Olefson
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Melissa Jackson
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David J. Grand
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin P. Charpentier
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nirav Makwana
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kittichai Promrat
- Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Correspondence to: Kittichai Promrat, Division of Gastroenterology and Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. Tel: +1-401-444-3575, Fax: +1-401-444-6316, E-mail:
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Use of Liver Magnetic Resonance Imaging After Standard Staging Abdominopelvic Computed Tomography to Evaluate Newly Diagnosed Colorectal Cancer Patients. Ann Surg 2015; 261:480-6. [DOI: 10.1097/sla.0000000000000708] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lee SS, Park SH. Radiologic evaluation of nonalcoholic fatty liver disease. World J Gastroenterol 2014; 20:7392-7402. [PMID: 24966609 PMCID: PMC4064084 DOI: 10.3748/wjg.v20.i23.7392] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/21/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a frequent cause of chronic liver diseases, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH)-related liver cirrhosis. Although liver biopsy is still the gold standard for the diagnosis of NAFLD, especially for the diagnosis of NASH, imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy. Ultrasonography is a well-established and cost-effective imaging technique for the diagnosis of hepatic steatosis, especially for screening a large population at risk of NAFLD. Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis, operator-dependent, and rather qualitative. Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard. However, computed tomography may be effective in specific clinical situations, such as evaluation of donor candidates for hepatic transplantation. Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice, especially for longitudinal follow-up of patients with NAFLD. Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis. This article will review current imaging methods used to evaluate hepatic steatosis, including the diagnostic accuracy, limitations, and practical applicability of each method. It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD.
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Maruzzelli L, Parr AJ, Miraglia R, Tuzzolino F, Luca A. Quantification of hepatic steatosis: a comparison of computed tomography and magnetic resonance indices in candidates for living liver donation. Acad Radiol 2014; 21:507-13. [PMID: 24594420 DOI: 10.1016/j.acra.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate, in a group of candidates for liver donation, the role of unenhanced computed tomography (CT) and magnetic resonance (MR) as noninvasive means to measure hepatic steatosis (HS). MATERIALS AND METHODS Sixty-one consecutive candidates underwent CT and MR evaluation for liver donation within 3 weeks of liver biopsy. On CT, three methods of HS quantification were evaluated: the measurement of hepatic attenuation (CT L), the ratio of hepatic attenuation to splenic attenuation (CT L/S), and the difference between the hepatic and splenic attenuation (CT L-S). On MR, HS was reported in terms of fat signal fraction (FSF) using in-phase/opposed-phase and fat/non-fat- saturated images, with and without normalization with the spleen (T1W IP/OP FSF, T1W IP/OP FSF spleen and T2W ± FS FSF, TW2 ± FS FSF spleen). The accuracy of each imaging index in the diagnosis of HS, according to various thresholds, was assessed using receiver operating characteristic analysis. RESULTS On biopsy, 35 donors showed no significant HS (<5%); the remaining 26 showed HS ranging from 5% to 40%. With all CT and MR indices, there was a trend toward increasing diagnostic accuracy as the threshold levels of HS increased. When comparing all the indices, TW2 ± FS FSF(spl) showed higher accuracy at threshold levels of 5% and 10% of steatosis but without reaching statistical significance. CONCLUSIONS In candidates for living donation, MR and CT indices are similar in estimating liver-fat content; however, MR with T2W ± FS FSF(spl) sequences shows higher accuracy when low threshold levels of steatosis (≤5% and ≤10% HS) are selected.
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Affiliation(s)
- Luigi Maruzzelli
- Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, Palermo, 90127 Italy.
| | - Anthony J Parr
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Roberto Miraglia
- Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, Palermo, 90127 Italy
| | - Fabio Tuzzolino
- Department of Information Technology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Angelo Luca
- Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, Palermo, 90127 Italy
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Natural History of Hepatic Steatosis: Observed Outcomes for Subsequent Liver and Cardiovascular Complications. AJR Am J Roentgenol 2014; 202:752-8. [DOI: 10.2214/ajr.13.11367] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Costa DMC, Salvadori PS, Monjardim RDF, Bretas EAS, Torres LR, Caldana RP, Shigueoka DC, Medeiros RB, D'ippolito G. When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000400004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.
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Monjardim RDF, Costa DMC, Romano RFT, Salvadori PS, Santos JDVCD, Atzingen ACV, Shigueoka DC, D'Ippolito G. Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000300005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and Methods In the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L - 0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results The simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity.
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S-1 plus oxaliplatin versus capecitabine plus oxaliplatin for first-line treatment of patients with metastatic colorectal cancer: a randomised, non-inferiority phase 3 trial. Lancet Oncol 2012; 13:1125-32. [PMID: 23062232 DOI: 10.1016/s1470-2045(12)70363-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Capecitabine plus oxaliplatin (CapeOX) is one of the reference doublet cytotoxic chemotherapy treatments for patients with metastatic colorectal cancer. We aimed to compare the efficacy and safety of CapeOX with that of S-1 plus oxaliplatin (SOX), a promising alternative treatment for patients with metastatic colorectal cancer. METHODS In this open-label, multicentre, randomised phase 3 trial, we randomly assigned patients (1:1) from 11 institutions in South Korea to receive either CapeOX (capecitabine 1000 mg/m(2) twice daily on days 1-14 and oxaliplatin 130 mg/m(2) on day 1) or SOX (S-1 40 mg/m(2) twice daily on days 1-14 and oxaliplatin 130 mg/m(2) on day 1). Treatment was repeated every 3 weeks and continued for as many as nine cycles of oxaliplatin-containing chemotherapy, except in instances of disease progression, unacceptable toxicity, or a patient's refusal. Maintenance chemotherapy with S-1 or capecitabine was allowed after discontinuation of oxaliplatin. Randomisation was done with a computer-generated sequence (stratified by primary sites, previous adjuvant or neoadjuvant treatment, and the presence of measurable lesions). The primary endpoint was to show non-inferiority of SOX relative to CapeOX in terms of progression-free survival (PFS). The primary analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00677443. FINDINGS Between May 14, 2008, and Sept 23, 2009, we randomly assigned 168 patients to receive SOX and 172 to receive CapeOX. Median PFS was 8·5 months (95% CI 7·6-9·3) in the SOX group and 6·7 months (6·2-7·1) in the CapeOX group (hazard ratio, 0·79 [95% CI 0·60-1·04]; p(non-inferiority)<0·0001, p(log-rank)=0·09). The upper limit of the CI was below the predefined margin of 1·43, showing the non-inferiority of SOX to CapeOX. We recorded a higher incidence of grade 3-4 neutropenia (49 [29%] vs 24 [15%]), thrombocytopenia (37 [22%] vs 11 [7%]), and diarrhoea (16 [10%] vs seven [4%]) in the SOX group than in the CapeOX group. The frequency of any grade of hand-foot syndrome was greater in the CapeOX group than it was in the SOX group (51 [31%] vs 23 [14%]). INTERPRETATION The SOX regimen could be an alternative first-line doublet chemotherapy strategy for patients with metastatic colorectal cancer. Further investigation is needed to explore its potential when used together with other targeted agents or as adjuvant chemotherapy. FUNDING Korea Healthcare Technology Research and Development Project, Ministry of Health and Welfare, South Korea.
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Kani K, Moshiri M, Cuevas C, Lee J, Mitsumori L, Kolokythas O. Imaging patterns of hepatic steatosis on multidetector CT: Pearls and pitfalls. Clin Radiol 2012; 67:366-71. [DOI: 10.1016/j.crad.2011.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 08/16/2011] [Accepted: 08/17/2011] [Indexed: 01/30/2023]
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Pickhardt PJ, Park SH, Hahn L, Lee SG, Bae KT, Yu ES. Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 2011; 22:1075-82. [PMID: 22138733 DOI: 10.1007/s00330-011-2349-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/17/2011] [Accepted: 10/27/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine a highly specific liver attenuation threshold at unenhanced CT for biopsy-proven moderate to severe hepatic steatosis (≥30% at histology). METHODS 315 asymptomatic adults (mean age ± SD, 31.5 ± 10.1 years; 207 men, 108 women) underwent same-day unenhanced liver CT and ultrasound-guided liver biopsy. Blinded to biopsy results, CT liver attenuation was measured using standard region-of-interest methodology. Multiple linear regression analysis was used to assess the relationship of CT liver attenuation with patient age, gender, BMI, CT system, and hepatic fat and iron content. RESULTS Thirty-nine subjects had moderate to severe steatosis and 276 had mild or no steatosis. A liver attenuation threshold of 48 HU was 100% specific (276/276) for moderate to severe steatosis, with no false-positives. Sensitivity, PPV and NPV at this HU threshold was 53.8%, 100% and 93.9%. Hepatic fat content was the overwhelming determinant of liver attenuation values, but CT system (P < 0.001), and hepatic iron (P = 0.035) also had a statistically significant independent association. CONCLUSIONS Unenhanced CT liver attenuation alone is highly specific for moderate to severe hepatic steatosis, allowing for confident non-invasive identification of large retrospective/prospective cohorts for natural history evaluation of incidental non-alcoholic fatty liver disease. Low sensitivity, however, precludes effective population screening at this threshold. KEY POINTS • Unenhanced CT liver attenuation is highly specific for diagnosing moderate/severe hepatic steatosis. • Unenhanced CT can identify large cohorts for epidemiological studies of incidental steatosis. • Unenhanced CT is not, however, effective for population screening for hepatic steatosis.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA
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