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Comparison of CT methods for determining graft steatosis in living donor liver transplantation

  • Mehmet ŞekerEmail author
  • Cengiz Erol
  • Şinasi Sevmiş
  • Burcu Saka
  • Afak Durur Karakaya
Hepatobiliary
  • 17 Downloads

Abstract

Purpose

To evaluate and compare the diagnostic performance of non-enhanced computed tomography (NECT) and contrast-enhanced CT (CECT) attenuation indices in the assessment of hepatic steatosis by using biopsy as the reference standard.

Materials and methods

This retrospective study was approved by our Institutional Review Board. 55 Potential donors who underwent both NECT and triphasic CECT and core liver biopsy, were included the study. Average attenuation measurements that were obtained from multiple regions in liver, spleen, and psoas muscle on both unenhanced and CECT were used for analysis. Hepatic attenuation measurements were analyzed with and without normalization with the spleen and psoas muscle. Linear regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the statistical association between CT indices and steatosis at histology.

Results

Linear regression analysis confirmed the strongest correlation between steatosis and normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT scan (R 0.821; R2 0.674 and R 0.816; R2 0.665, respectively). The use of ROC curve analysis also demonstrated that normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT showed high diagnostic performance regarding the qualitative distinction of steatosis (AUC values greater than 0.9).

Conclusion

Attenuation measurements of liver normalized with spleen on hepatic venous phase may be useful in evaluating steatosis in donor candidates with moderate to severe steatosis who are unacceptable for liver donation. In this manner unnecessary liver biopsy may be avoided in those donor candidates.

Keywords

Hepatic steatosis Living donor liver transplantation (LDLT) Contrast-enhanced CT Non-enhanced CT 

Notes

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to disclose.

Ethical approval

This study was approved by our Institutional Review Board.

Informed consent

All subjects gave written informed consent.

Supplementary material

261_2019_1993_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)

References

  1. 1.
    Schroeder T, Radtke A, Kuehl H, et al. Evaluation of living liver donors with an all-inclusive 3D multi-detector row CT protocol. Radiology 2006; 238:900–910.  https://doi.org/10.1148/radiol.2382050133.CrossRefGoogle Scholar
  2. 2.
    Adam R, McMaster P, O’Grady JG, et al. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003; 9: 1231–1243.  https://doi.org/10.1016/j.lts.2003.09.018.CrossRefGoogle Scholar
  3. 3.
    Vohra S, Goyal N, Gupta S. Preoperative CT evaluation of potential donors in living donor liver transplantation. Indian J Radiol Imaging 2014;24:350–359.  https://doi.org/10.4103/0971-3026.143897.CrossRefGoogle Scholar
  4. 4.
    Vetelainen R, van Vliet A, Gouma DJ, et al. Steatosis as a risk factor in liver surgery. Ann Surg 2007;245:20–30.  https://doi.org/10.1097/01.sla.0000225113.88433.cf.CrossRefGoogle Scholar
  5. 5.
    Trevisani F, Colantoni A, Caraceni P, et al. The use of donor fatty liver for liver transplantation: a challenge or a quagmire? J Hepatol. 1996; 22:114–121.CrossRefGoogle Scholar
  6. 6.
    Adam R, Reynes M, Johann M, et al. The outcome of steatotic grafts in liver transplantation. Transplant Proc. 1991;23:1538–1540.Google Scholar
  7. 7.
    Behrns KE, Tsiotos GG, DeSouza NF, et al. Hepatic steatosis as a potential risk factor for major hepatic resection. J Gastrointest Surg.1998;2:292–298.CrossRefGoogle Scholar
  8. 8.
    Nagai S, Fujimoto Y, Kamei H, Nakamura T, Kiuchi T. Mild hepatic macrovesicular steatosis may be a risk factor for hyperbilirubinaemia in living liver donors following right hepatectomy. British Journal of Surgery 2009;96: 437–444.  https://doi.org/10.1002/bjs.6479.CrossRefGoogle Scholar
  9. 9.
    Tsang LL, Chen CL, Huang TL, et al. Preoperative imaging evaluation of potential living liver donors: reasons for exclusion from donation in adult living donor liver transplantation. Transplant Proc. 2008;40:2460–2.  https://doi.org/10.1016/j.transproceed.2008.07.075.CrossRefGoogle Scholar
  10. 10.
    McCormack L, Clavien P.A. Understanding the meaning of fat in the liver. Liver Transpl. 2005; 11: 137.  https://doi.org/10.1002/lt.20354.CrossRefGoogle Scholar
  11. 11.
    Shah SA, Grant DR, Greig PD, et al. Analysis and outcomes of right lobe hepatectomy in 101 consecutive living donors. Am J Transplant 2005; 5: 2764–2769.  https://doi.org/10.1111/j.1600-6143.2005.01094.x.CrossRefGoogle Scholar
  12. 12.
    Nadalin S, Malago M, Valentin-Gamazo C, et al. Preoperative donor liver biopsy for adult living donor liver transplantation: risks and benefits. Liver Transpl 2005; 11: 980–986.  https://doi.org/10.1002/lt.20462.CrossRefGoogle Scholar
  13. 13.
    Dorwal P, Gautam D, Sharma D, et al. Donor biopsy in living donor liver transplantation: is it still relevant in a developing country? Malaysian J Pathol. 2015;37:39–43.Google Scholar
  14. 14.
    Brandhagen D, Fidler J, Rosen C. Evaluation of the donor liver for living donor liver transplantation. Liver Transpl 2003;9(10 Suppl 2):S16–S28.CrossRefGoogle Scholar
  15. 15.
    Hwang I, Lee JM, Lee KB et al. Hepatic steatosis in living liver donor candidates: preoperative assessment by using breath-hold triple-echo MR imaging and 1H MR spectroscopy. Radiology 2014;271(3):730–738.  https://doi.org/10.1148/radiol.14130863.CrossRefGoogle Scholar
  16. 16.
    Trotter JF. Selection of donors for living donor liver transplantation. Liver Transplant 2003;9:S2–S7.  https://doi.org/10.1053/jlts.2003.50221.CrossRefGoogle Scholar
  17. 17.
    Park SH, Kim PN, Kim KW, et al. Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 2006;239:105–112.  https://doi.org/10.1148/radiol.2391050361.CrossRefGoogle Scholar
  18. 18.
    Chen YS, Cheng YF, De Villa VH, et al. Evaluation of living liver donors. Transplantation 2003;75 (suppl 3):S16–S19.  https://doi.org/10.1097/01.TP.0000046535.49186.EB.CrossRefGoogle Scholar
  19. 19.
    Xiaozhou Ma X, Holalkere NS, Kambadakone RA, et al. Imaging-based quantification of hepatic fat: methods and clinical applications. Radiographics. 2009;29:1253–1280.  https://doi.org/10.1148/rg.295085186.
  20. 20.
    van Werven JR, Marsman HA, Nederveen AJ, Smits NJ, ten Kate FJ, van Gulik TM, et al. Assessment of hepatic steatosis in patients undergoing liver resection: Comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010;256:159–68.  https://doi.org/10.1148/radiol.10091790.
  21. 21.
    Lee SW, Park SH, Kim KW, et al. Unenhanced CT for Assessment of Macrovesicular Hepatic Steatosis in Living Liver Donors: Comparison of Visual Grading with Liver Attenuation Index. Radiology 2007;244(2):479–85.  https://doi.org/10.1148/radiol.2442061177.CrossRefGoogle Scholar
  22. 22.
    Kim SH, Lee JM, Han JK, et al. Hepatic macrosteatosis: predicting appropriateness of liver donation by using MR imaging-correlation with histopathologic findings. Radiology 2006;240(1):116–129.  https://doi.org/10.1148/radiol.2393042218.CrossRefGoogle Scholar
  23. 23.
    Russo MW, Brown RS Jr. Russo MW, Brown RS. Is the cost of adult living donor liver transplantation higher than deceased donor liver transplantation? Liver Transpl. 2004;10:467–468.  https://doi.org/10.1002/lt.20102.
  24. 24.
    Kodama Y, Ng CS, Wu TT, et al. Comparison of CT methods for determining the fat content of the liver. AJR 2007;188:1307–12.  https://doi.org/10.2214/AJR.06.0992.CrossRefGoogle Scholar
  25. 25.
    Limanond P, Raman SS, Lassman C, et al. Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology 2004;230: 276–280.  https://doi.org/10.1148/radiol.2301021176.CrossRefGoogle Scholar
  26. 26.
    Kim DY, Park SH, Lee SS, et al. Contrast-enhanced computed tomography for the diagnosis of fatty liver: prospective study with same-day biopsy used as the reference standard. Eur Radiol. 2010;20:359–66.  https://doi.org/10.1007/s00330-009-1560-x.CrossRefGoogle Scholar
  27. 27.
    Jacobs JE, Birnbaum BA, Shapiro MA, et al. Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT. AJR 1998;171:659–64.  https://doi.org/10.2214/ajr.171.3.9725292.CrossRefGoogle Scholar
  28. 28.
    Johnston RJ, Stamm ER, Lewin JM, et al. Diagnosis of fatty infiltration of the liver on contrast enhanced CT: limitations of liver-minus-spleen attenuation difference measurements. Abdom Imaging 1998;23:409–15.CrossRefGoogle Scholar
  29. 29.
    Lawrence DA, Oliva IB, Israel GM. Detection of hepatic steatosis on contrast-enhanced CT images: diagnostic accuracy of identification of areas of presumed focal fatty sparing. AJR Am J Roentgenol. 2012;199:44–47.  https://doi.org/10.2214/AJR.11.7838.CrossRefGoogle Scholar
  30. 30.
    Panicek DM, Giess CS, Schwartz LH. Qualitative assessment of liver for fatty infiltration on contrastenhanced CT: is muscle a better standard of reference than spleen? J Comput Assist Tomogr 1997; 21: 699–705.CrossRefGoogle Scholar
  31. 31.
    Park YS, Park SH, Lee SS, Kim DY, Shin YM, Lee W, et al. Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology 2011;258(3):760–6.  https://doi.org/10.1148/radiol.10101233.CrossRefGoogle Scholar
  32. 32.
    Iwasaki M, Takada Y, Hayashi M, et al. Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 2004;78:1501–1505.CrossRefGoogle Scholar
  33. 33.
    Saba L, di Martino M, Bosco S, del Monte M, de Cecco CN, Lombardo V et al. MDCT classification of steatotic liver: a multicentric analysis. Eur J Gastroenterol Hepatol 2015; 27(3):290–297.  https://doi.org/10.1097/MEG.0000000000000277.CrossRefGoogle Scholar
  34. 34.
    Balci A, Karazincir S, Sumbas H, Oter Y, Egilmez E, Inandi T. Effects of diffuse fatty infiltration of the liver on portal vein flow hemodynamics. J Clin Ultrasound 2008; 36:134–140.  https://doi.org/10.1002/jcu.20440.CrossRefGoogle Scholar
  35. 35.
    Ijaz S, Yang W, Winslet MC, Seifalian AM. Impairment of hepatic microcirculation in fatty liver. Microcirculation 2003; 10 (6): 447–456.  https://doi.org/10.1038/sj.mn.7800206.CrossRefGoogle Scholar
  36. 36.
    Seifalian AM, Chidambaram V, Rolles K, Davidson BR. In vivo demonstration of impaired microcirculation in steatotic human liver grafts. Liver Transpl Surg 1998; 4:71–77.CrossRefGoogle Scholar
  37. 37.
    Seifalian AM, Piasecki C, Agarwal A, Davidson BR. The effect of graded steatosis on flow in the hepatic parenchymal microcirculation. Transplantation 1999; 68 (6):780–784.CrossRefGoogle Scholar
  38. 38.
    Alpern MB, Lawson TL, Foley WD, et al. Focal hepatic masses and fatty infiltration detected by enhanced dynamic CT. Radiology 1986;158:45–49.  https://doi.org/10.1148/radiology.158.1.3940396.CrossRefGoogle Scholar
  39. 39.
    Speliotes E.K, Massaro J.M, Hoffmann U, Vasan RS, Meigs JB, Sahani DV, et al. Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study. J Gastroenterol Hepatol. 2008;23(6):894–899.  https://doi.org/10.1111/j.1440-1746.2008.05420.x.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Faculty of MedicineMedipol UniversityIstanbulTurkey
  2. 2.Department of SurgeryYeni Yuzyıl UniversityIstanbulTurkey
  3. 3.Department of Pathology, Faculty of MedicineMedipol UniversityIstanbulTurkey

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