PubMed Central On the other hand, focal sparing in a diffusely fatty liver can be observed most frequently around the gallbladder bed, and its most common shape resembles a spot, band or ring (6). ; Oliva, I.B. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients, https://doi.org/10.1007/s00261-015-0605-7, Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma, Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran, Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre, Application of new ultrasound techniques for focal liver lesions, Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules, Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography, Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability, Uncommon imaging evolutions of focal liver lesions in cirrhosis, Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art, http://creativecommons.org/licenses/by/4.0/. Lu, Y.; Lin, Y.; Huang, X.; Wu, S.; Wei, J.; Yang, C. Oxaliplatin aggravates hepatic oxidative stress, inflammation and fibrosis in a non-alcoholic fatty liver disease mouse model. most exciting work published in the various research areas of the journal. Fatty Liver Grade three || Diffuse Fatty infiltration || Focal fatty sparingLiver: Normal in size. Grieco, A.; Forgione, A.; Miele, L.; Greco, A.V. The aim of the study was to determine the sonographic prevalence of benign focal liver lesions on the basis of a population of hospital patients. Variables found to be associated with both the exposure and outcome and thus, probably confounders, were selected as covariates based on a review of relevant literature. CTAP showed a wedge-shaped ischemic area. The most common site of these pseudo lesions are hepatic segments IV and V, the gallbladder bed, the falciform ligament region, and ventral to the portal vein. It is important for the subsequent diagnosis and therapy and the associated expended time and effort of the treating physician and the affected patientto say nothing of the related coststhat the focus visible on ultrasound is classified as reliably as possible [4]. (2010) Prevalence and risk factors of focal sparing in hepatic steatosis. Of 269 patients, 76 (28.3%) had steatosis at baseline. ; Brett, E.M.; Garber, A.J. These conclusions have critical implications on the quality of life and hepatic function of patients not only in the curative setting, but may also be applicable in the setting of treatment of metastatic disease, in particular in context of patients requiring liver resections for metastases in addition to indefinite metastatic treatment which may require up to 60 cycles of 5-FU-based chemotherapy. Location. (2001) Incidence and significance of small focal liver lesions in MRI. The prevalence of FNH lies between 0.8% and 3.2% [1215], of hepatic adenoma from 0.4% to 1.5% [11, 12, 15, 16], and of focal fatty sparing between 7.2% and 19.8% [8, 17, 18]. PubMed On sonography, the entire liver showed increased echogenicity, suggestive of fat deposition. It was suggested that this fibrotic liver tissue corresponded to the area of focal sparing seen on CT and MR images. For continuous variables, the mean and standard deviation were calculated, while categorical attributes were presented in absolute and relative frequencies. Naturally, these cannot be recorded in retrospective ultrasound prevalence studies. The majority of the more recent ultrasound-based prevalence studies show significantly higher prevalence figures than older ultrasound-based studies (Table4). Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. AJR Am J Roentgenol 162:11191122, Article Wolfgang Dhnert. We recently experienced a case of metastatic liver tumor masquerading as a wedge-shaped area of focal sparing in a fatty liver. Saif, M.W. Of these patients, 103 individuals were treated with an oxaliplatin-containing regimen, which is FOLFOX. 2 test for categorical variables, unless the sample size was too small, in which case Fishers exact test was used. At the time the article was last revised Raymond Chieng had (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). 4 and 5). Friedman, S.L. Focal fatty liver (FFL) or focal steatosis is localised or patchy process of lipid accumulation in the liver. Other variables included clinical data pertaining to their cancer and variables that may influence steatosis development, such as tumour location, whether primary surgical resection was performed, pelvic radiation status, steroid use, statin use, alcohol consumption, and duration and type of adjuvant chemotherapy received. Current Oncology. On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). In this study, Stage IIIII colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. Oncol. ; Lawson, T.L. Mostbeck GH (1996) Ultrasound screening examination of the abdomen: of value or senseless? In many cases, the phenomenon is believed to be related to the hemodynamics of a third inflow . J Ultrasound Med 14:7780, Karcaaltincaba M, Akhan O (2007) Imaging of hepatic steatosis and fatty sparing. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. The serum total bilirubin level rose to 19.9 mg/dl on the 11th postoperative day. Severe and Late Acute Liver Injury Induced by Capecitabine. Radiology. 4).MRI is very useful for making the diagnosis of focal hepatic steatosis, which appears isointense or hyperintense to liver on in-phase images and loses signal on out-of-phase images. The heart and lungs were clear to auscultation and palpation of the liver revealed no abnormality. Semin Liver Dis 33:236247, Article Patients with focal fatty sparing are more often male and have a higher BMI and a larger liver than patients with nonalcoholic fatty liver disease without focal fatty sparing. Hepatic pseudolesion: appearance of focal low attenuation in the medial segment of the left lobe at CT arterial portography. articles published under an open access Creative Common CC BY license, any part of the article may be reused without ; Tanimoto, A.; Baba, Y.; Zhao, L.; Chen, J.; Middleton, M.S. You seem to have javascript disabled. If no unequivocal and/or acceptable statements about the above-mentioned parameters could be made from the re-inspected ultrasound images, these were expanded and/or measured again. Note: data are presented as frequency (percent), unless otherwise specified. (c) Opposed-phase MR images show a hyperintense area in the entirely hypointense liver (TR = 120, TE = 2.1). The examinations were evaluated for the presence of a focal area of increased attenuation in the liver in locations where focal fatty sparing typically occurs: adjacent to the gallbladder fossa and in the medial segment of the left lobe near the porta hepatis. Lee, M.C.M. ; Siu, L.L. The prevalence data published so far on hepatic adenoma are between 0.4% and 1.7%. Ultrasound features only become apparent when the amount of fat reaches 15-20%. CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. Woods, C.P. It was suggested that the tumor caused this ischemia due to intrahepatic portal vein blockade. Results that were incomplete or ambiguous were excluded from this study. Abdominal ultrasound, particularly of the liver, is a widely available, inexpensive technique that can be rapidly performed without exposing the patient to radiation. 2. Note: data are presented as frequency (percent), unless otherwise specified. analyzed and interpreted the data. ; Foley, W.D. When located in characteristic locations then there is usually little difficulty in making the correct diagnosis. Habib, M.B. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. CAS was determined through a review of radiology reports, and images were reviewed by a single radiologist to maximize inter-rater reliability. In our population, a maximum occurred at between 41 and 50years of age. Conclusions The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion. In our study, this figure fell almost linearly with increasing age and amounted to only 66.8% in the group of patients over 70years of age. The aim of this study was to evaluate the prevalence of hepatic hemangioma, FNH, hepatic cysts, focal fatty sparing, and hepatic adenoma in a large population of university hospital patients and to compare this with the values published in the literature. However, it occasionally creates some problems in the diagnosis of hepatic mass lesions. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. Current status of imaging in nonalcoholic fatty liver disease. It was most often found in the 5160years age group; the mean age of the patients with focal fatty sparing was 54.914.5years. Baseline and . Furthermore, there are only a few prevalence studies based on CT, MRI investigations, and autopsy studies [11, 12, 15, 16]. Here, we observed that there is a trend towards a higher rate of CAS development within one year of follow-up among stage IIIII CRC patients who received chemotherapy compared to the no treatment group. J Clin Ultrasound 21:115118, Gaines PA, Sampson MA (1989) The prevalence and characterization of simple hepatic cysts by ultrasound examination. All ultrasonographic examinations were performed in the ultrasound unit by experienced physicians. However, while elevated levels of liver biochemical tests often correlate with a diagnosis of fatty liver, a high proportion of patients with NAFLD exhibit normal liver profiles, making these tests inappropriate diagnostic markers that may not have drastically impacted the findings presented in our study [. ; Neuschwander-Tetri, B.A. Zentralbl Chir 123:119123, CAS and Strunk et al. Is hepatic steatosis reversible? Alcoholic fatty liver may be accompanied by inflammation and necrosis (alcoholic hepatitis) and permanent damage in the form of cirrhosis. Capecitabine: An overview of the side effects and their management. ; Dobbins, R.; Nuremberg, P.; Horton, J.D. The highest prevalence was found in younger women, and 86.4% (n=70) of all patients with FNH were females. The calculated prevalence of benign focal liver lesions shows that on the fortuitous discovery of space-occupying lesions of the liver, first consideration should be given to focal fatty sparing, simple hepatic cysts and hemangiomas. Differential diagnosis Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. ; McKillop, J.H. Ultrasound Q 23:7980, Kester NL, Elmore SG (1995) Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. Besides the clinical parameters and the patients medical history, the quality of the ultrasound equipment used and the investigators experience also play a significant role. Curr. As with hemangioma, there are a comparatively large number of prevalence studies for hepatic cysts, but they also differ in terms of study size, patient populations investigated, and diagnostic techniques used. From six or more foci upwards, these were combined as more than five lesions. The information about lesion size was based on the maximum measurable diameter in each case. Unable to process the form. Please note that many of the page functionalities won't work as expected without javascript enabled. In rare cases, focal fatty sparing has also been described in other liver segments where, in the first instance, it is generally difficult to distinguish from malignant lesions and can hence pose considerable problems for a differential diagnosis [2426]. ; Kim, T.K. The point estimate is consistent with moderately increased risk of steatosis, but with wide confidence intervals (, We then examined the 135 patients who received adjuvant chemotherapy. Am J Clin Pathol 29:160162, Rungsinaporn K, Phaisakamas T (2008) Frequency of abnormalities detected by upper abdominal ultrasound. Comparison of the study results is also difficult, because the studies differ with regard to the selection of the population investigated, the number of individuals investigated, and the diagnostic method used [ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) or autopsy]. A total of 44.9% of these patients were outpatients and 55.1% inpatients. ; Lee, K.S. J Ultrasound Med 14:649652, Feldman M (1958) Hemangioma of the liver. The research group of Koseoglu reported a prevalence of focal fatty sparing of up to 19.8 [18] Strunk et al. A characteristic location for focal hepatosteatosis is the medial segment of the left lobe of the liver ( segment 4) either anterior to the porta hepatis or adjacent to the falciform ligament 1. On admission, his general condition was good. No specific therapy is available except to eliminate the cause or treat the underlying disorder. Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. Data of 45,319 patients (48.5% women and 51.48% men) were analyzed using a PC-based, standardized documentation system (ViewPoint GE Healthcare GmbH Wessling/Oberpfaffenhofen, Germany). (2001) Frequency of benign hepatic lesions incidentally detected with contrast-enhanced thin-section portal venous phase spiral CT. Acta Radiol 42:172520, Lam KY (2002) Autopsy findings in diabetic patients: a 27year clinicopathologic study with emphasi on opportunistic infections and cancers. Br J Radiol 62:335337, Aubin B, Denys A, Lafortune M, Dry R, Breton G (1995) Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels. Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. Search for other works by this author on: Department of Pathology, Gifu University School of Medicine, Focal spared areas in fatty liver caused by regional decreased portal flow, Nodular focal fatty infiltration of the liver: CT appearance, Multifocal fatty infiltration of the liver: report of six cases, A case of focal fatty liver difficult to distinguish from the liver metastasis of rectal cancer on CT, Focal sparing around the gallbladder in fatty liver: a useful sign for the diagnosis of borderline cases by CT, Focal manifestations of diffuse liver disease at MR imaging, Focal spared area in fatty liver simulaing a mass: Scintigraphic evaluation, Focal sparing in fatty infiltration of the liver, Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver, Liver metastases from ovarian cystadenocarcinoma masquarading on CT as lobar fatty infiltration, Metastatic tumors in irregular fatty liver mimicking focal sparing, Projection of the number of new cancer cases in the world, Cross-cultural comparison of continuous deep sedation for advanced cancer patients in East Asian countries: prospective cohort study, The efficacy and safety of trastuzumab deruxtecan (T-DXd) in HER2-expressing solid tumours: a single-arm meta-analysis, A new era of the Asian clinical research network: a report from the ATLAS international symposium, Factors affecting polyglycolic acid sheet engraftment success for covering mucosal defects from head and neck surgery, About Japanese Journal of Clinical Oncology, Receive exclusive offers and updates from Oxford Academic. In many cases, the phenomenon is believed to be related to the haemodynamics of a third inflow. M.C.M.L. ; Finn, J.P.; Stark, D.D. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. positive feedback from the reviewers. Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). This distribution is the same as that seen in focal fatty sparing and is thought to relate to variations in vascular supply. Part of Springer Nature. Patients had consecutively presented from January 2003 to November 2013 and had undergone abdominal ultrasound for a variety of diseases or for preventive medical examination in the university hospital. Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer. The largest measured cyst diameter averaged 22.3mm. Vigano, L.; De Rosa, G.; Toso, C.; Andres, A.; Ferrero, A.; Roth, A.; Sperti, E.; Majno, P.; Rubbia-Brandt, L. Reversibility of chemotherapy-related liver injury. The electronic medical records of these patients were reviewed. (2012) Prevalence of non-cardiac pathology on clinical transthoracic echocardiography. Non-enhanced CT demonstrated a fatty liver associated with a wedge-shaped hyperdense area which occupied almost all of the anterior segment of the right lobe (Fig. Unusual patterns of hepatic steatosis caused by the local effect of insulin revealed on chemical shift MR imaging. Retrospective and prospective studies based on ultrasound have reported prevalence data for hepatic cysts of between 0.1% and 11.3% [7, 9, 23, 29]. 4) disclosed irregular enhancement in the anterior segment, as seen on dynamic MR images. Serum electrolytes, blood urea nitrogen, creatinine, glucose, total bilirubin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), leucine aminopeptidase (LAP) and gamma-glutamyltranspeptidase (g-GTP) were all within the normal ranges. Used criteria for the diagnosis of the lesions are presented in Table1. Following parameters were recorded and evaluated on the basis of the above-mentioned research question: positive/negative finding, nature of tumor, age and gender of the patient, number of foci (solitary, multiple), the respective ultrasound characteristics of the focus and size of the tumor (maximum diameter). An elliptical mass surrounded by a halo was seen in the anterior segment of the right lobe, and its internal echogenicity was irregular (Fig. A Feature An association between the occurrence of benign focal liver lesions and age was observed. Postoperative liver insufficiency and sepsis were diagnosed and intensive care including plasma exchange and administration of vancomycin was performed. At least one of the lesions to be investigated was diagnosed in 15.1% (n=6839) of the patients of the total population. acquired and interpreted radiology image data. The sample size of 37 in the statin group meant that the power of the statistical analysis was smaller than the widely accepted threshold of 80%. Diagnosis of fatty liver disease: Is biopsy necessary? Radiology Review Manual. The present case revealed a wedge-shaped area with an almost linear boundary and did not show a mass effect in the non-enhanced CT and MR sequence, including chemical shift images. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). 2). Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-1344, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1344,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/focal-hepatic-steatosis/questions/1098?lang=gb"}. methods, instructions or products referred to in the content. Color and power Doppler sonography were performed in 80 patients with a fatty liver that appeared as a fine echogenic pattern with considerable deep attenuation on sonography. In summary, our results show that the first possibility to be considered on the incidental discovery of space-occupying lesions of the liverespecially if hepatic steatosis is presentis focal fatty sparing.
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