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Gastrointestinal
Diagnosis
Liver
Inflammation
Steatosis and Steatohepatitis
Steatosis and Steatohepatitis
Michael P. Federle, MD, FACR
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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 metabolic complication of 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. Castera L et al: Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 156(5):1264-81.e4, 2019
                                            2. Flisiak-Jackiewicz M et al: Update on pathogenesis, diagnostics and therapy of nonalcoholic fatty liver disease in children. Clin Exp Hepatol. 5(1):11-21, 2019
                                            3. Gu J et al: Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol. 29(7):3564-73, 2019
                                            4. Manka P et al: Fibrosis in chronic liver disease: an update on diagnostic and treatment Modalities. Drugs. 79(9):903-27, 2019
                                            5. Marchisello S et al: Pathophysiological, molecular and therapeutic issues of nonalcoholic fatty liver disease: an overview. Int J Mol Sci. 20(8), 2019
                                            6. Zhou JH et al: Noninvasive evaluation of nonalcoholic fatty liver disease: current evidence and practice. World J Gastroenterol. 25(11):1307-26, 2019
                                            7. Zhang Y et al: Comparison of CT and magnetic resonance mDIXON-Quant sequence in the diagnosis of mild hepatic steatosis. Br J Radiol. 91(1091):20170587, 2018
                                            8. Middleton MS et al: Agreement between magnetic resonance imaging proton density fat fraction measurements and pathologist-assigned steatosis grades of liver biopsies from adults with nonalcoholic steatohepatitis. Gastroenterology. 153(3):753-61, 2017
                                            9. Chang W et al: Liver fibrosis staging with MR elastography: comparison of diagnostic performance between patients with chronic hepatitis B and those with other etiologic causes. Radiology. 280(1):88-97, 2016
                                            10. Idilman IS et al: Hepatic steatosis: etiology, patterns, and quantification. Semin Ultrasound CT MR. 37(6):501-10, 2016
                                            11. Karanjia RN et al: Hepatic steatosis and fibrosis: Non-invasive assessment. World J Gastroenterol. 22(45):9880-97, 2016
                                            12. Pais TP et al: Multiple liver lesions of unusual benign etiology mimicking metastatic disease. Gastroenterology. 147(2):e10-1, 2014
                                            13. Zoppini G et al: Mortality from chronic liver diseases in diabetes. Am J Gastroenterol. 109(7):1020-5, 2014
                                            14. Raptis DA et al: MRI: the new reference standard in quantifying hepatic steatosis? Gut. 61(1):117-27, 2012
                                            15. Lazo M et al: Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 343(7832):d6891, 2011
                                            16. 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
                                            17. Mansour S et al: Non-alcoholic steatohepatitis mimicking liver metastasis in obesity surgery. Dig Endosc. 23(4):316-8, 2011
                                            18. 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
                                            19. 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
                                            20. 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
                                            21. Ma X et al: Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 29(5):1253-77, 2009
                                            22. Cowin GJ et al: Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging. 28(4):937-45, 2008
                                            23. 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
                                            24. Jou J et al: Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis. 28(4):370-9, 2008
                                            25. 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
                                            26. Kemper J et al: CT and MRI findings of multifocal hepatic steatosis mimicking malignancy. Abdom Imaging. 27(6):708-10, 2002
                                            27. 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
                                            28. 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 metabolic complication of 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. Castera L et al: Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 156(5):1264-81.e4, 2019
                                                                                      2. Flisiak-Jackiewicz M et al: Update on pathogenesis, diagnostics and therapy of nonalcoholic fatty liver disease in children. Clin Exp Hepatol. 5(1):11-21, 2019
                                                                                      3. Gu J et al: Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol. 29(7):3564-73, 2019
                                                                                      4. Manka P et al: Fibrosis in chronic liver disease: an update on diagnostic and treatment Modalities. Drugs. 79(9):903-27, 2019
                                                                                      5. Marchisello S et al: Pathophysiological, molecular and therapeutic issues of nonalcoholic fatty liver disease: an overview. Int J Mol Sci. 20(8), 2019
                                                                                      6. Zhou JH et al: Noninvasive evaluation of nonalcoholic fatty liver disease: current evidence and practice. World J Gastroenterol. 25(11):1307-26, 2019
                                                                                      7. Zhang Y et al: Comparison of CT and magnetic resonance mDIXON-Quant sequence in the diagnosis of mild hepatic steatosis. Br J Radiol. 91(1091):20170587, 2018
                                                                                      8. Middleton MS et al: Agreement between magnetic resonance imaging proton density fat fraction measurements and pathologist-assigned steatosis grades of liver biopsies from adults with nonalcoholic steatohepatitis. Gastroenterology. 153(3):753-61, 2017
                                                                                      9. Chang W et al: Liver fibrosis staging with MR elastography: comparison of diagnostic performance between patients with chronic hepatitis B and those with other etiologic causes. Radiology. 280(1):88-97, 2016
                                                                                      10. Idilman IS et al: Hepatic steatosis: etiology, patterns, and quantification. Semin Ultrasound CT MR. 37(6):501-10, 2016
                                                                                      11. Karanjia RN et al: Hepatic steatosis and fibrosis: Non-invasive assessment. World J Gastroenterol. 22(45):9880-97, 2016
                                                                                      12. Pais TP et al: Multiple liver lesions of unusual benign etiology mimicking metastatic disease. Gastroenterology. 147(2):e10-1, 2014
                                                                                      13. Zoppini G et al: Mortality from chronic liver diseases in diabetes. Am J Gastroenterol. 109(7):1020-5, 2014
                                                                                      14. Raptis DA et al: MRI: the new reference standard in quantifying hepatic steatosis? Gut. 61(1):117-27, 2012
                                                                                      15. Lazo M et al: Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 343(7832):d6891, 2011
                                                                                      16. 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
                                                                                      17. Mansour S et al: Non-alcoholic steatohepatitis mimicking liver metastasis in obesity surgery. Dig Endosc. 23(4):316-8, 2011
                                                                                      18. 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
                                                                                      19. 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
                                                                                      20. 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
                                                                                      21. Ma X et al: Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 29(5):1253-77, 2009
                                                                                      22. Cowin GJ et al: Magnetic resonance imaging and spectroscopy for monitoring liver steatosis. J Magn Reson Imaging. 28(4):937-45, 2008
                                                                                      23. 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
                                                                                      24. Jou J et al: Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis. 28(4):370-9, 2008
                                                                                      25. 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
                                                                                      26. Kemper J et al: CT and MRI findings of multifocal hepatic steatosis mimicking malignancy. Abdom Imaging. 27(6):708-10, 2002
                                                                                      27. 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
                                                                                      28. 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
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