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Hepatic Steatosis
Aya Kamaya, MD, FSRU, FSAR; Amir M. Pirmoazen, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Fatty liver disease, hepatic fatty metamorphosis
            • Definitions

              • Steatosis is metabolic complication of variety of toxic, ischemic, and infectious insults to liver
              • Excessive lipid accumulation in ≥ 5% of hepatocytes based on histologic analysis (reference standard)
              • Most common etiologies
                • Nonalcoholic fatty liver disease (NAFLD)
                • Alcoholic fatty liver disease

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Pirmoazen AM et al: Quantitative ultrasound approaches for diagnosis and monitoring hepatic steatosis in nonalcoholic fatty liver disease. Theranostics. 10(9):4277-89, 2020
                                            2. Sugimoto K et al: The role of multiparametric US of the liver for the evaluation of nonalcoholic steatohepatitis. Radiology. 296(3):532-40, 2020
                                            3. Li Q et al: Current status of imaging in nonalcoholic fatty liver disease. World J Hepatol. 10(8):530-42, 2018
                                            4. Younossi Z et al: Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 15(1):11-20, 2018
                                            5. Younossi ZM et al: Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 64(1):73-84, 2016
                                            6. Loomba R et al: Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology. 60(6):1920-8, 2014
                                            7. Borges VF et al: Sonographic hepatorenal ratio: a noninvasive method to diagnose nonalcoholic steatosis. J Clin Ultrasound. 41(1):18-25, 2013
                                            8. Kwon HJ et al: Value of the ultrasound attenuation index for noninvasive quantitative estimation of hepatic steatosis. J Ultrasound Med. 32(2):229-35, 2013
                                            9. Lazo M et al: Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 178(1):38-45, 2013
                                            10. Lee MJ et al: Liver steatosis assessment: correlations among pathology, radiology, clinical data and automated image analysis software. Pathol Res Pract. 209(6):371-9, 2013
                                            11. Perito ER et al: Targeted hepatic sonography during clinic visits for detection of fatty liver in overweight children: a pilot study. J Ultrasound Med. 32(4):637-43, 2013
                                            12. Zelber-Sagi S et al: Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification. World J Gastroenterol. 19(1):57-64, 2013
                                            13. Ballestri S et al: Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver Int. 32(8):1242-52, 2012
                                            14. Baršić N et al: Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease. World J Gastroenterol. 18(30):3945-54, 2012
                                            15. Ghamar-Chehreh ME et al: Predictive factors for ultrasonographic grading of nonalcoholic fatty liver disease. Hepat Mon. 12(11):e6860, 2012
                                            16. Lawrence DA et al: Detection of hepatic steatosis on contrast-enhanced CT images: diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 199(1):44-7, 2012
                                            17. Marshall RH et al: Hepatorenal index as an accurate, simple, and effective tool in screening for steatosis. AJR Am J Roentgenol. 199(5):997-1002, 2012
                                            18. Shannon A et al: Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr. 53(2):190-5, 2011
                                            19. Webb M et al: Diagnostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis. AJR Am J Roentgenol. 192(4):909-14, 2009
                                            20. Hamer OW et al: Fatty liver: imaging patterns and pitfalls. Radiographics. 26(6):1637-53, 2006
                                            21. Rubaltelli L et al: Targetlike appearance of pseudotumors in segment IV of the liver on sonography. AJR Am J Roentgenol. 178(1):75-7, 2002
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Fatty liver disease, hepatic fatty metamorphosis
                                                      • Definitions

                                                        • Steatosis is metabolic complication of variety of toxic, ischemic, and infectious insults to liver
                                                        • Excessive lipid accumulation in ≥ 5% of hepatocytes based on histologic analysis (reference standard)
                                                        • Most common etiologies
                                                          • Nonalcoholic fatty liver disease (NAFLD)
                                                          • Alcoholic fatty liver disease

                                                      IMAGING

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nuclear Medicine Findings

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Pirmoazen AM et al: Quantitative ultrasound approaches for diagnosis and monitoring hepatic steatosis in nonalcoholic fatty liver disease. Theranostics. 10(9):4277-89, 2020
                                                                                      2. Sugimoto K et al: The role of multiparametric US of the liver for the evaluation of nonalcoholic steatohepatitis. Radiology. 296(3):532-40, 2020
                                                                                      3. Li Q et al: Current status of imaging in nonalcoholic fatty liver disease. World J Hepatol. 10(8):530-42, 2018
                                                                                      4. Younossi Z et al: Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 15(1):11-20, 2018
                                                                                      5. Younossi ZM et al: Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 64(1):73-84, 2016
                                                                                      6. Loomba R et al: Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology. 60(6):1920-8, 2014
                                                                                      7. Borges VF et al: Sonographic hepatorenal ratio: a noninvasive method to diagnose nonalcoholic steatosis. J Clin Ultrasound. 41(1):18-25, 2013
                                                                                      8. Kwon HJ et al: Value of the ultrasound attenuation index for noninvasive quantitative estimation of hepatic steatosis. J Ultrasound Med. 32(2):229-35, 2013
                                                                                      9. Lazo M et al: Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 178(1):38-45, 2013
                                                                                      10. Lee MJ et al: Liver steatosis assessment: correlations among pathology, radiology, clinical data and automated image analysis software. Pathol Res Pract. 209(6):371-9, 2013
                                                                                      11. Perito ER et al: Targeted hepatic sonography during clinic visits for detection of fatty liver in overweight children: a pilot study. J Ultrasound Med. 32(4):637-43, 2013
                                                                                      12. Zelber-Sagi S et al: Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification. World J Gastroenterol. 19(1):57-64, 2013
                                                                                      13. Ballestri S et al: Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver Int. 32(8):1242-52, 2012
                                                                                      14. Baršić N et al: Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease. World J Gastroenterol. 18(30):3945-54, 2012
                                                                                      15. Ghamar-Chehreh ME et al: Predictive factors for ultrasonographic grading of nonalcoholic fatty liver disease. Hepat Mon. 12(11):e6860, 2012
                                                                                      16. Lawrence DA et al: Detection of hepatic steatosis on contrast-enhanced CT images: diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 199(1):44-7, 2012
                                                                                      17. Marshall RH et al: Hepatorenal index as an accurate, simple, and effective tool in screening for steatosis. AJR Am J Roentgenol. 199(5):997-1002, 2012
                                                                                      18. Shannon A et al: Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr. 53(2):190-5, 2011
                                                                                      19. Webb M et al: Diagnostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis. AJR Am J Roentgenol. 192(4):909-14, 2009
                                                                                      20. Hamer OW et al: Fatty liver: imaging patterns and pitfalls. Radiographics. 26(6):1637-53, 2006
                                                                                      21. Rubaltelli L et al: Targetlike appearance of pseudotumors in segment IV of the liver on sonography. AJR Am J Roentgenol. 178(1):75-7, 2002