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Steatosis and Steatohepatitis
Michael P. Federle, MD, FACR
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19

KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Hepatic steatosis or hepatic fatty metamorphosis
              • Nonalcoholic steatohepatitis (NASH)
            • Definitions

              • Characterized by accumulation of increasing amounts of triglycerides within hepatocytes
              • Steatosis is a metabolic complication of a variety of toxic, ischemic, and infectious insults to liver

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Pais TP et al: Multiple liver lesions of unusual benign etiology mimicking metastatic disease. Gastroenterology. 147(2):e10-1, 2014
                                            2. Zoppini G et al: Mortality from chronic liver diseases in diabetes. Am J Gastroenterol. 109(7):1020-5, 2014
                                            3. Raptis DA et al: MRI: the new reference standard in quantifying hepatic steatosis? Gut. 61(1):117-27, 2012
                                            4. Lazo M et al: Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 343(7832):d6891, 2011
                                            5. Lee SS et al: Hepatic fat quantification using chemical shift MR imaging and MR spectroscopy in the presence of hepatic iron deposition: validation in phantoms and in patients with chronic liver disease. J Magn Reson Imaging. 33(6):1390-8, 2011
                                            6. Mansour S et al: Non-alcoholic steatohepatitis mimicking liver metastasis in obesity surgery. Dig Endosc. 23(4):316-8, 2011
                                            7. Marsman HA et al: Hepatic steatosis assessment with CT or MRI in patients with colorectal liver metastases after neoadjuvant chemotherapy. J Surg Oncol. 104(1):10-6, 2011
                                            8. Rastogi A et al: Steatosis in chronic hepatitis B: prevalence and correlation with biochemical, histologic, viral, and metabolic parameters. Indian J Pathol Microbiol. 54(3):454-9, 2011
                                            9. Meng K et al: Metabolic syndrome and ectopic fat deposition: what can CT and MR provide? Acad Radiol. 17(10):1302-12, 2010
                                            10. Kalra N et al: Chemical shift magnetic resonance imaging is helpful in detecting hepatic steatosis but not fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Ann Hepatol. 8(1):21-5, 2009
                                            11. Ma X et al: Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 29(5):1253-77, 2009
                                            12. Tobari M et al: Imaging of nonalcoholic steatohepatitis: advantages and pitfalls of ultrasonography and computed tomography. Intern Med. 48(10):739-46, 2009
                                            13. Vuppalanchi R et al: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management. Hepatology. 49(1):306-17, 2009
                                            14. Younossi ZM et al: Metabolic syndrome, non-alcoholic fatty liver disease and hepatitis C virus: impact on disease progression and treatment response. Liver Int. 29 Suppl 2:3-12, 2009
                                            15. Zhong L et al: Nonalcoholic fatty liver disease: quantitative assessment of liver fat content by computed tomography, magnetic resonance imaging and proton magnetic resonance spectroscopy. J Dig Dis. 10(4):315-20, 2009
                                            16. Bahl M et al: Liver steatosis: investigation of opposed-phase T1-weighted liver MR signal intensity loss and visceral fat measurement as biomarkers. Radiology. 249(1):160-6, 2008
                                            17. Castera L: Non-invasive diagnosis of steatosis and fibrosis. Diabetes Metab. 34(6 Pt 2):674-9, 2008
                                            18. Cheung O et al: Hepatitis C infection and nonalcoholic fatty liver disease. Clin Liver Dis. 12(3):573-85, viii-ix, 2008
                                            19. Cowin GJ et al: Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging. 28(4):937-45, 2008
                                            20. Furlan A et al: Multiple hepatic adenomas associated with liver steatosis at CT and MRI: a case-control study. AJR Am J Roentgenol. 191(5):1430-5, 2008
                                            21. Jou J et al: Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis. 28(4):370-9, 2008
                                            22. Park SH et al: Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology. 239(1):105-12, 2006
                                            23. Kemper J et al: CT and MRI findings of multifocal hepatic steatosis mimicking malignancy. Abdom Imaging. 27(6):708-10, 2002
                                            24. 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
                                            25. Outwater EK et al: Detection of lipid in abdominal tissues with opposed-phase gradient-echo images at 1.5 T: techniques and diagnostic importance. Radiographics. 18(6):1465-80, 1998
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Hepatic steatosis or hepatic fatty metamorphosis
                                                        • Nonalcoholic steatohepatitis (NASH)
                                                      • Definitions

                                                        • Characterized by accumulation of increasing amounts of triglycerides within hepatocytes
                                                        • Steatosis is a metabolic complication of a variety of toxic, ischemic, and infectious insults to liver

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Pais TP et al: Multiple liver lesions of unusual benign etiology mimicking metastatic disease. Gastroenterology. 147(2):e10-1, 2014
                                                                                      2. Zoppini G et al: Mortality from chronic liver diseases in diabetes. Am J Gastroenterol. 109(7):1020-5, 2014
                                                                                      3. Raptis DA et al: MRI: the new reference standard in quantifying hepatic steatosis? Gut. 61(1):117-27, 2012
                                                                                      4. Lazo M et al: Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 343(7832):d6891, 2011
                                                                                      5. Lee SS et al: Hepatic fat quantification using chemical shift MR imaging and MR spectroscopy in the presence of hepatic iron deposition: validation in phantoms and in patients with chronic liver disease. J Magn Reson Imaging. 33(6):1390-8, 2011
                                                                                      6. Mansour S et al: Non-alcoholic steatohepatitis mimicking liver metastasis in obesity surgery. Dig Endosc. 23(4):316-8, 2011
                                                                                      7. Marsman HA et al: Hepatic steatosis assessment with CT or MRI in patients with colorectal liver metastases after neoadjuvant chemotherapy. J Surg Oncol. 104(1):10-6, 2011
                                                                                      8. Rastogi A et al: Steatosis in chronic hepatitis B: prevalence and correlation with biochemical, histologic, viral, and metabolic parameters. Indian J Pathol Microbiol. 54(3):454-9, 2011
                                                                                      9. Meng K et al: Metabolic syndrome and ectopic fat deposition: what can CT and MR provide? Acad Radiol. 17(10):1302-12, 2010
                                                                                      10. Kalra N et al: Chemical shift magnetic resonance imaging is helpful in detecting hepatic steatosis but not fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Ann Hepatol. 8(1):21-5, 2009
                                                                                      11. Ma X et al: Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 29(5):1253-77, 2009
                                                                                      12. Tobari M et al: Imaging of nonalcoholic steatohepatitis: advantages and pitfalls of ultrasonography and computed tomography. Intern Med. 48(10):739-46, 2009
                                                                                      13. Vuppalanchi R et al: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management. Hepatology. 49(1):306-17, 2009
                                                                                      14. Younossi ZM et al: Metabolic syndrome, non-alcoholic fatty liver disease and hepatitis C virus: impact on disease progression and treatment response. Liver Int. 29 Suppl 2:3-12, 2009
                                                                                      15. Zhong L et al: Nonalcoholic fatty liver disease: quantitative assessment of liver fat content by computed tomography, magnetic resonance imaging and proton magnetic resonance spectroscopy. J Dig Dis. 10(4):315-20, 2009
                                                                                      16. Bahl M et al: Liver steatosis: investigation of opposed-phase T1-weighted liver MR signal intensity loss and visceral fat measurement as biomarkers. Radiology. 249(1):160-6, 2008
                                                                                      17. Castera L: Non-invasive diagnosis of steatosis and fibrosis. Diabetes Metab. 34(6 Pt 2):674-9, 2008
                                                                                      18. Cheung O et al: Hepatitis C infection and nonalcoholic fatty liver disease. Clin Liver Dis. 12(3):573-85, viii-ix, 2008
                                                                                      19. Cowin GJ et al: Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging. 28(4):937-45, 2008
                                                                                      20. Furlan A et al: Multiple hepatic adenomas associated with liver steatosis at CT and MRI: a case-control study. AJR Am J Roentgenol. 191(5):1430-5, 2008
                                                                                      21. Jou J et al: Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis. 28(4):370-9, 2008
                                                                                      22. Park SH et al: Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology. 239(1):105-12, 2006
                                                                                      23. Kemper J et al: CT and MRI findings of multifocal hepatic steatosis mimicking malignancy. Abdom Imaging. 27(6):708-10, 2002
                                                                                      24. 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
                                                                                      25. Outwater EK et al: Detection of lipid in abdominal tissues with opposed-phase gradient-echo images at 1.5 T: techniques and diagnostic importance. Radiographics. 18(6):1465-80, 1998