Uneven steatosis and focal spared areas: modifications in the echographic pattern during chemotheraphy and clinical correlations

Abstract

Hepatic steatosis induced by antiblastic chemotheraphy leads to differential diagnostic problems. It is difficult to recognize the true nature of hypoechoic areas in fatty liver in neoplastic patients treated by chemotheraphy, because “skip areas” due to nonsteatotic parenchyma and metastases may have very similar appearances. We studied with sonography 61 patients during chemotherapy and at different times during follow-up. The US findings were compared with laboratory data (liver function tests, serum cholesterol, and triglycerides). The final diagnosis was made by CT examination and/or liver biopsy. No correlations were found between US and laboratory data. However, a mean time could be determined for the occurrence of hepatic steatosis (diffuse steatosis: 72 days, SD ± 15 days; focal steatosis: 53 days, SD ± 12 days) as well as for its regression (53 days, SD ± 9 days for diffuse steatosis and 62 days, SD ± 15 days for focal steatosis) in close temporal relationship with previous chemotheraphy. These data might be of diagnostic value in the US assessment of neoplastic patients upon follow-up. In fact, focal hypoechoic areas occuring within the mean expected time in which steatosis takes place should more likely be benign (skip areas), and as such, disappear when liver steatosis regresses. On the contrary, the persistence of such images as well as their appearance beyond the expected mean time for hepatic steatosis to occur are highly suspicious for metastases and require further diagnostic work-up (CT, biopsy).