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Journal of Medical Ultrasonics

, Volume 40, Issue 4, pp 393–398 | Cite as

Frequency and implication of focal fatty sparing in segmental homogeneous fatty liver at ultrasound

  • Size WuEmail author
  • Rong Tu
  • Guangqing Liu
Original Article
  • 306 Downloads

Abstract

Purpose

The purpose of this study was to investigate whether focal fatty sparing arises from preexisting segmental homogeneous nonalcoholic fatty liver (NAFL).

Methods

Patients with various patterns of fatty liver were recruited from among 16,127 people, and 132 participants with segmental homogeneous NAFL were followed during the second year. All participants underwent ultrasonography. The sonographic findings in segmental homogeneous NAFL were analyzed.

Results

Of the 16,127 participants, 1,619 had fatty liver (10.0 %), and of these 1,568 had NAFL (9.72 %) and 51 had alcoholic fatty liver (0.31 %). Of the 1,568 patients with NAFL, 176 had homogeneous fatty liver with focal fatty sparing (11.2 %), 132 had segmental homogeneous fatty liver (8.42 %), and the rest had other patterns. At follow-up, of the 132 patients with segmental homogeneous fatty liver, 3 (2.3 %) were found to have a normal liver and 26 (19.7 %) diffuse homogeneous and heterogeneous fatty liver, and no focal fatty sparing was found (P < 0.001).

Conclusions

Focal fatty sparing usually does not arise in preexisting segmental homogeneous NAFL. This implies that newly appearing nodular hypoechogenicity in segmental homogeneous fatty liver is more likely to be a true lesion rather than focal fatty sparing.

Keywords

Liver steatosis Focal Ultrasound 

Notes

Acknowledgments

The authors would like to express their gratitude to Professor Li Huang, Ruxia Nan, and radiologists in ultrasonography Ying Guan, Enhai Zheng, Shibin Lin, Chuan Fu, and Kailiang Chen for their assistance. This study was supported by the Health Department of Hainan Province (no. 2011-47).

Conflict of interest

The authors declare there is no conflict of interest concerning this article.

References

  1. 1.
    Milić S, Stimac D. Nonalcoholic fatty liver disease/steatohepatitis: epidemiology, pathogenesis, clinical presentation and treatment. Dig Dis. 2012;30:158–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Chitturi S, Wong VW, Farrell G. Nonalcoholic fatty liver in Asia: firmly entrenched and rapidly gaining ground. J Gastroenterol Hepatol. 2011;26 Suppl 1:163–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Eguchi Y, Hyogo H, Ono M, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol. 2012;47:586–95.PubMedCrossRefGoogle Scholar
  4. 4.
    Chen CH, Huang MH, Yang JC, et al. Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of Taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol. 2006;40:745–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Caballería L, Pera G, Auladell MA, et al. Prevalence and factors associated with the presence of nonalcoholic fatty liver disease in an adult population in Spain. Eur J Gastroenterol Hepatol. 2010;22:24–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Ascha MS, Hanouneh IA, Lopez R, et al. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology. 2010;51:1972–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Cheung O, Sanyal AJ. Recent advances in nonalcoholic fatty liver disease. Curr Opin Gastroenterol. 2010;26:202–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Yoshimitsu K, Honda H, Kuroiwa T, et al. Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT. Radiographics. 2001;21 Spec No:S81–96.PubMedGoogle Scholar
  9. 9.
    Karcaaltincaba M, Akhan O. Imaging of hepatic steatosis and fatty sparing. Eur J Radiol. 2007;61:33–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Bhatnagar G, Sidhu HS, Vardhanabhuti V, et al. The varied sonographic appearances of focal fatty liver disease: review and diagnostic algorithm. Clin Radiol. 2012;67:372–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Itai Y. Targetlike focal spared area of the liver: definite imaging diagnosis. AJR Am J Roentgenol. 2002;179:1071–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Kemper J, Jung G, Poll LW, et al. CT and MRI findings of multifocal hepatic steatosis mimicking malignancy. Abdom Imaging. 2002;27:708–10.PubMedCrossRefGoogle Scholar
  13. 13.
    McKenzie A, Gill G, McIntosh R, et al. Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver. Australas Radiol. 1991;35:166–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Fujikawa K, Shiraki K, Ito T, et al. Focal spared area in fatty liver mimicking a tumor. Hepatogastroenterology. 2002;49:1253–4.PubMedGoogle Scholar
  15. 15.
    Kawamori Y, Matsui O, Takahashi S, et al. Focal hepatic fatty infiltration in the posterior edge of the medial segment associated with aberrant gastric venous drainage: CT, US, and MR findings. J Comput Assist Tomogr. 1996;20:356–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Bashir Y. Focal fatty infiltration of the liver mimicking metastatic disease. Postgrad Med J. 1990;66:290–1.PubMedCrossRefGoogle Scholar
  17. 17.
    Kyogoku S, Shiraishi A, Ozaki Y, et al. Focal sparing of segment 2 in fatty liver: US appearance. Radiat Med. 2004;22:342–5.PubMedGoogle Scholar
  18. 18.
    Chong VF, Fan YF. Ultrasonographic hepatic pseudolesions: normal parenchyma mimicking mass lesions in fatty liver. Clin Radiol. 1994;49:326–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Battaglia DM, Wanless IR, Brady AP, et al. Intrahepatic sequestered segment of liver presenting as focal fatty change. Am J Gastroenterol. 1995;90:2238–9.PubMedGoogle Scholar
  20. 20.
    Terayama N, Matsui O, Tatsu H, et al. Focal sparing of fatty liver in segment II associated with aberrant left gastric vein. Br J Radiol. 2004;77:150–2.PubMedCrossRefGoogle Scholar
  21. 21.
    Gabata T, Matsui O, Kadoya M, et al. Aberrant gastric venous drainage in a focal spared area of segment IV in fatty liver: demonstration with color Doppler sonography. Radiology. 1997;203:461–3.PubMedGoogle Scholar
  22. 22.
    Kurosaki Y, Tanaka YO, Itai Y. Aberrant gastric venous drainage in focal fatty liver of segment IV: demonstration with sonography. AJR Am J Roentgenol. 1998;171:897–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Yoon KH, Matsui O, Kadoya M, et al. Pseudolesion in segments II and III of the liver on CT during arterial portography caused by aberrant right gastric venous drainage. J Comput Assist Tomogr. 1999;23:306–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Gabata T, Matsui O, Kadoya M, et al. Aberrant gastric venous drainage into the medial segment: demonstration by color Doppler sonography. Abdom Imaging. 1997;22:502–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Hiwatashi A, Yoshimitsu K, Honda H, et al. Pseudolesion in segment II of the liver observed on CT during arterial portography caused by the aberrant left gastric venous drainage. Abdom Imaging. 1999;24:357–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Yamagami T, Arai Y, Takeuchi Y, et al. Focal fatty change in segment IV of the liver occurring after gastrectomy. Br J Radiol. 1998;71:888–91.PubMedGoogle Scholar
  27. 27.
    Arai K, Matsui O, Takashima T, et al. Focal spared areas in fatty liver caused by regional decreased portal flow. AJR Am J Roentgenol. 1988;151:300–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Arita T, Matsunaga N, Honma Y, et al. Focally spared area of fatty liver caused by arterioportal shunt. J Comput Assist Tomogr. 1996;20:360–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Fukukura Y, Fujiyoshi F, Inoue H, et al. Focal fatty infiltration in the posterior aspect of hepatic segment IV: relationship to pancreaticoduodenal venous drainage. Am J Gastroenterol. 2000;95:3590–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Aubin B, Denys A, Lafortune M, et al. Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels. J Ultrasound Med. 1995;14:77–80.PubMedGoogle Scholar
  31. 31.
    Tochio H, Kudo M, Okabe Y, et al. Association between a focal spared area in the fatty liver and intrahepatic efferent blood flow from the gallbladder wall: evaluation with color Doppler sonography. AJR Am J Roentgenol. 1999;172:1249–53.PubMedCrossRefGoogle Scholar
  32. 32.
    Nakayama T, Yoshimitsu K, Masuda K. Pseudolesion in segment IV of the liver with focal fatty deposition caused by the parabiliary venous drainage. Comput Med Imaging Graph. 2000;24:259–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Kobayashi S, Matsui O, Kadoya M, et al. CT arteriographic confirmation of focal hepatic fatty infiltration adjacent to the falciform ligament associated with drainage of inferior vein of Sappey: a case report. Radiat Med. 2001;19:51–4.PubMedGoogle Scholar
  34. 34.
    Kobayashi S, Matsui O, Gabata T. Pseudolesion in segment IV of the liver adjacent to the falciform ligament caused by drainage of the paraumbilical vein: demonstration by power Doppler ultrasound. Br J Radiol. 2001;74:273–6.PubMedGoogle Scholar
  35. 35.
    Yoshikawa J, Matsui O, Takashima T, et al. Focal fatty change of the liver adjacent to the falciform ligament: CT and sonographic findings in five surgically confirmed cases. AJR Am J Roentgenol. 1987;149:491–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Genchellac H, Yilmaz S, Ucar A, et al. Hepatic pseudolesion around the falciform ligament: prevalence, aberrant venous supply, and fatty infiltration evaluated by multidetector computed tomography and magnetic resonance imaging. J Comput Assist Tomogr. 2007;31:526–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Kester NL, Elmore SG. Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. J Ultrasound Med. 1995;14:649–52.PubMedGoogle Scholar
  38. 38.
    Murakami T, Kim T, Sugiura T, et al. Focally spared area of fatty liver that receives blood passing through the sinusoids of a hypervascular hepatocellular carcinoma. J Comput Assist Tomogr. 1999;23:320–2.PubMedCrossRefGoogle Scholar
  39. 39.
    Spelle L, Soyer P, Rondeau Y, et al. Nontumorous hepatic pseudolesion around the falciform ligament: prevalence on gadolinium chelate-enhanced MR examination. AJR Am J Roentgenol. 1997;169:795–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Soyer P, Sirol M, Fargeaudou Y, et al. Differentiation between true focal liver lesions and pseudolesions in patients with fatty liver: evaluation of helical CT criteria. Eur Radiol. 2010;20:1726–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Konno K, Ishida H, Sato M, et al. Liver tumors in fatty liver: difficulty in ultrasonographic interpretation. Abdom Imaging. 2001;26:487–91.PubMedCrossRefGoogle Scholar
  42. 42.
    Marsh JI, Gibney RG, Li DK. Hepatic hemangioma in the presence of fatty infiltration: an atypical sonographic appearance. Gastrointest Radiol. 1989;14:262–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Wu WC, Chen SC, Dia CY, et al. Coexistence of focal nodular hyperplasia and pseudotumor caused by focal spared lesion in the liver of a young man. J Gastroenterol Hepatol. 2003;18:1320–2.PubMedCrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2013

Authors and Affiliations

  1. 1.Department of Medical ImagingThe Affiliated Hospital of Hainan Medical CollegeHaikouChina
  2. 2.Department of RadiologyThe Affiliated Hospital of Hainan Medical CollegeHaikouChina
  3. 3.Department of UltrasoundThe Affiliated Hospital of Hainan Medical CollegeHaikouChina

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