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Macrovesicular Hepatic Steatosis in Living Liver Donors: Use of CT for Quantitative and Qualitative Assessment¹

¹ From the Department of Radiology (S.H.P., P.N.K., K.W.K., S.W.L., S.E.Y., H.K.H., M.G.L.), Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery (S.H., S.G.L.), and Department of Diagnostic Pathology (E.S.Y.), University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Gu, 138-040 Seoul, Korea; Department of Radiology, Eulji University School of Medicine, Eulji Hospital, Seoul, Korea (S.W.P.); and Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea (E.Y.C.). Received March 2, 2005; revision requested April 27; revision received May 16; accepted June 13; final version accepted July 5. Address correspondence to P.N.K. (e-mail: pnkim{at}amc.seoul.kr).

Purpose: To determine prospectively the diagnostic performance of unenhanced computed tomography (CT) in the assessment of macrovesicular steatosis in potential donors for living donor liver transplantation by using same-day biopsy as a reference standard.

Materials and Methods: Institutional review board approval and informed consent were obtained. A total of 154 candidates, including 104 men (mean age, 30.2 years ± 10.3 [standard deviation]) and 50 women (mean age, 31.8 years ± 11.2), underwent same-day unenhanced CT and ultrasonography-guided liver biopsy. Histologic degree of macrovesicular steatosis was determined. Three liver attenuation indices were derived: liver-to-spleen attenuation ratio (CT_L/S), difference between hepatic and splenic attenuation (CT_L–S), and blood-free hepatic parenchymal attenuation (CT_LP). Regression equations were used to quantitatively estimate the degree of macrovesicular steatosis. Limits of agreement between estimated macrovesicular steatosis and the reference standard were calculated. Receiver operating characteristic analyses were used to determine the performance of each index for qualitative diagnosis of macrovesicular steatosis of 30% or greater. The cutoff value that provided a balance between sensitivity and specificity and the highest cutoff value that yielded 100% specificity were determined.

Results: Limits of agreement were –14% to 14% for CT_L/S and CT_L–S and –13% to 13% for CT_LP. Performance in diagnosing macrovesicular steatosis of 30% or greater was not significantly different among indices (P > .05). Cutoff values of 0.9, –7, and 58 were determined for CT_L/S, CT_L–S, and CT_LP, respectively, and provided a balance between sensitivity and specificity. Cutoff values of 0.8, –9, and 42 were determined for CT_L/S, CT_L–S, and CT_LP, respectively, and yielded 100% specificity for all indices, with corresponding sensitivities of 82%, 82%, and 73% for CT_L/S, CT_L–S, and CT_LP, respectively.

Conclusion: Diagnostic performance of unenhanced CT for quantitative assessment of macrovesicular steatosis is not clinically acceptable. Unenhanced CT, however, provides high performance in qualitative diagnosis of macrovesicular steatosis of 30% or greater.

© RSNA, 2006

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