HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Limanond, P. Articles by Lu, D. S. K. Search for Related Content PubMed PubMed Citation Articles by Limanond, P. Articles by Lu, D. S. K.

Macrovesicular Hepatic Steatosis in Living Related Liver Donors: Correlation between CT and Histologic Findings¹

¹ From the Departments of Radiology (P.L., S.S.R., J.S., D.S.K.L.), Pathology (C.L.), Surgery (R.M.G., R.W.B.), and Digestive Diseases (S.S.), David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095-1721. Received September 13, 2002; revision requested November 22; final revision received April 30, 2003; accepted May 20. Address correspondence to S.S.R. (e-mail: SRaman@mednet.ucla.edu).

PURPOSE: To assess degree of macrovesicular steatosis with unenhanced computed tomography (CT) and correlate it with histologic findings in potential donors for living related liver transplantation.

MATERIALS AND METHODS: Forty-two candidates underwent unenhanced CT within 4 weeks of core liver biopsy. An experienced liver pathologist, blinded to both CT and surgical findings, retrospectively reviewed biopsy specimens and determined degree of macrovesicular steatosis. A radiologist blinded to histologic grading calculated mean hepatic attenuation in each donor liver by averaging 25 region-of-interest (ROI) measurements on five sections (five ROIs per section). Mean splenic attenuation was calculated with three separate ROI measurements. Liver attenuation index (LAI) was derived and defined as the difference between mean hepatic and mean splenic attenuation. Body mass index (BMI) was determined for each patient. Linear regression analysis was used to correlate degree of macrovesicular steatosis with both LAI and BMI.

RESULTS: LAI correctly predicted degree of macrovesicular steatosis in 38 (90%) of 42 cases. In four of four livers, LAI below -10 HU correlated with greater than 30% macrovesicular steatosis (unacceptable for liver transplantation). In nine of 11 livers, LAI was between -10 and 5 HU and correctly predicted 6%–30% steatosis (relative contraindication). In two of 11 cases, LAI overestimated degree of hepatic steatosis. LAI above 5 HU correctly predicted 0%–5% steatosis in 25 of 27 livers. In two of 27 cases, parenchymal hemosiderin deposition led to an increase in LAI into the normal range, despite mild histologically confirmed steatosis. Degree of histologic macrovesicular steatosis correlated well with LAI (r = 0.92) and marginally with BMI (r = 0.45). Of 27 potential donors with normal livers at CT and acceptable LAI levels, four (15%) were deemed poor donor candidates because core biopsy revealed subtle hepatic necrosis and nonspecific hepatitis.

CONCLUSION: Although unenhanced CT quantifies the degree of macrovesicular steatosis relatively well, it may preclude a liver biopsy only in a small percentage of potential donors with low LAI (unacceptable degree of steatosis). Core liver biopsy is still necessary in the majority of donors with normal LAI to identify those with both fatty liver and coexistent hemosiderin deposition or radiologically occult diffuse liver diseases.

© RSNA, 2004

Index terms: Liver, CT, 761.12111, 761.12115 • Liver, fatty, 761.50 • Liver, transplantation

This article has been cited by other articles:

				M. Bahl, A. Qayyum, A. C. Westphalen, S. M. Noworolski, P. W. Chu, L. Ferrell, P. C. Tien, N. M. Bass, and R. B. Merriman Liver Steatosis: Investigation of Opposed-Phase T1-weighted Liver MR Signal Intensity Loss and Visceral Fat Measurement as Biomarkers Radiology, October 1, 2008; 249(1): 160 - 166. [Abstract] [Full Text] [PDF]

				S. W. Lee, S. H. Park, K. W. Kim, E. K. Choi, Y. M. Shin, P. N. Kim, K. H. Lee, E. S. Yu, S. Hwang, and S.-G. Lee Unenhanced CT for Assessment of Macrovesicular Hepatic Steatosis in Living Liver Donors: Comparison of Visual Grading with Liver Attenuation Index Radiology, August 1, 2007; 244(2): 479 - 485. [Abstract] [Full Text] [PDF]

				Y. Kodama, C. S. Ng, T. T. Wu, G. D. Ayers, S. A. Curley, E. K. Abdalla, J. N. Vauthey, and C. Charnsangavej Comparison of CT Methods for Determining the Fat Content of the Liver Am. J. Roentgenol., May 1, 2007; 188(5): 1307 - 1312. [Abstract] [Full Text] [PDF]

				O. W. Hamer, D. A. Aguirre, G. Casola, J. E. Lavine, M. Woenckhaus, and C. B. Sirlin Fatty Liver: Imaging Patterns and Pitfalls RadioGraphics, November 1, 2006; 26(6): 1637 - 1653. [Abstract] [Full Text] [PDF]

				A.-J. Lemke, M. J. Brinkmann, T. Schott, S. M. Niehues, U. Settmacher, P. Neuhaus, and R. Felix Living Donor Right Liver Lobes: Preoperative CT Volumetric Measurement for Calculation of Intraoperative Weight and Volume Radiology, September 1, 2006; 240(3): 736 - 742. [Abstract] [Full Text] [PDF]

				F. G.S. Toledo, A. D. Sniderman, and D. E. Kelley Influence of Hepatic Steatosis (Fatty Liver) on Severity and Composition of Dyslipidemia in Type 2 Diabetes Diabetes Care, August 1, 2006; 29(8): 1845 - 1850. [Abstract] [Full Text] [PDF]

				S. H. Kim, J. M. Lee, J. K. Han, J. Y. Lee, K. H. Lee, C. J. Han, J. Y. Jo, N.-J. Yi, K.-S. Suh, K.-S. Shin, et al. Hepatic Macrosteatosis: Predicting Appropriateness of Liver Donation by Using MR Imaging--Correlation with Histopathologic Findings Radiology, July 1, 2006; 240(1): 116 - 129. [Abstract] [Full Text] [PDF]

				S. H. Park, P. N. Kim, K. W. Kim, S. W. Lee, S. E. Yoon, S. W. Park, H. K. Ha, M.-G. Lee, S. Hwang, S.-G. Lee, et al. Macrovesicular Hepatic Steatosis in Living Liver Donors: Use of CT for Quantitative and Qualitative Assessment Radiology, April 1, 2006; 239(1): 105 - 112. [Abstract] [Full Text] [PDF]

				T. Schroeder, A. Radtke, H. Kuehl, J. F. Debatin, M. Malago, and S. G. Ruehm Evaluation of Living Liver Donors with an All-inclusive 3D Multi-Detector Row CT Protocol Radiology, March 1, 2006; 238(3): 900 - 910. [Abstract] [Full Text] [PDF]

				A. Qayyum, J. S. Goh, S. Kakar, B. M. Yeh, R. B. Merriman, and F. V. Coakley Accuracy of Liver Fat Quantification at MR Imaging: Comparison of Out-of-Phase Gradient-Echo and Fat-saturated Fast Spin-Echo Techniques--Initial Experience Radiology, November 1, 2005; 237(2): 507 - 511. [Abstract] [Full Text] [PDF]

				O. W. Hamer, D. A. Aguirre, G. Casola, and C. B. Sirlin Imaging Features of Perivascular Fatty Infiltration of the Liver: Initial Observations Radiology, October 1, 2005; 237(1): 159 - 169. [Abstract] [Full Text] [PDF]

				S. H. Kim, J. M. Lee, J. H. Kim, K. G. Kim, J. K. Han, K. H. Lee, S. H. Park, N.-J. Yi, K.-S. Suh, S. K. An, et al. Appropriateness of a Donor Liver with Respect to Macrosteatosis: Application of Artificial Neural Networks to US Images--Initial Experience Radiology, March 1, 2005; 234(3): 793 - 803. [Abstract] [Full Text] [PDF]