GASTROINTESTINAL IMAGING: Liver
Case Author: Hanna M. Zafar, MD, MHS, University of Pennsylvania
History
55-year-old man with left flank pain; CT has been performed, and a recommendation based on the findings must be made.
Imaging Findings
Axial unenhanced CT images (A and B) show diffuse low attenuation of the liver (–2 HU). An ill-defined area of higher attenuation is present along the periphery of the liver (arrow, B). Coronal reformatted image (C) shows hepatic enlargement with a craniocaudal length of 25 cm.
Recommendation
Referral to a hepatologist
Teaching Points
Hepatic steatosis is present in more than 35% of the U.S. population; 4–5% of persons with hepatic steatosis eventually develop cirrhosis.
Hepatic attenuation of less than 48 HU on unenhanced CT images is indicative of hepatic steatosis.
MRI of hepatic steatosis shows decreased signal intensity of the liver on opposed-phase gradient-echo images compared with in-phase images owing to chemical shift artifact. Several MRI-based techniques are under development for quantification of liver fat. These noninvasive methods may be valuable for accurate diagnosis of hepatic steatosis and monitoring of therapy.
Suggested Readings
Meng K, Lee CH, Saremi F. Metabolic syndrome and ectopic fat deposition: what can CT and MR provide? Acad Radiol 2010; 17:1302–1312
Reeder SB, Sirlin C. Quantification of liver fat with magnetic resonance imaging. Magn Reson Imaging Clin N Am 2010; 18:337–357
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