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Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis

  • Gastrointestinal
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Abstract

Objectives

To determine a highly specific liver attenuation threshold at unenhanced CT for biopsy-proven moderate to severe hepatic steatosis (≥30% at histology).

Methods

315 asymptomatic adults (mean age ± SD, 31.5 ± 10.1 years; 207 men, 108 women) underwent same-day unenhanced liver CT and ultrasound-guided liver biopsy. Blinded to biopsy results, CT liver attenuation was measured using standard region-of-interest methodology. Multiple linear regression analysis was used to assess the relationship of CT liver attenuation with patient age, gender, BMI, CT system, and hepatic fat and iron content.

Results

Thirty-nine subjects had moderate to severe steatosis and 276 had mild or no steatosis. A liver attenuation threshold of 48 HU was 100% specific (276/276) for moderate to severe steatosis, with no false-positives. Sensitivity, PPV and NPV at this HU threshold was 53.8%, 100% and 93.9%. Hepatic fat content was the overwhelming determinant of liver attenuation values, but CT system (P < 0.001), and hepatic iron (P = 0.035) also had a statistically significant independent association.

Conclusions

Unenhanced CT liver attenuation alone is highly specific for moderate to severe hepatic steatosis, allowing for confident non-invasive identification of large retrospective/prospective cohorts for natural history evaluation of incidental non-alcoholic fatty liver disease. Low sensitivity, however, precludes effective population screening at this threshold.

Key Points

• Unenhanced CT liver attenuation is highly specific for diagnosing moderate/severe hepatic steatosis.

• Unenhanced CT can identify large cohorts for epidemiological studies of incidental steatosis.

• Unenhanced CT is not, however, effective for population screening for hepatic steatosis.

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Author information

Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA

    Perry J. Pickhardt & Luke Hahn

  2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, Korea

    Seong Ho Park

  3. Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, Korea

    Sung-Gyu Lee

  4. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, Korea

    Eun Sil Yu

  5. Department of Radiology, University of Pittsburgh, 3950 Presbyterian South Tower, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Kyongtae T. Bae

Authors
  1. Perry J. Pickhardt
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  2. Seong Ho Park
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Correspondence to Seong Ho Park.

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Pickhardt, P.J., Park, S.H., Hahn, L. et al. Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 22, 1075–1082 (2012). https://doi.org/10.1007/s00330-011-2349-2

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  • DOI: https://doi.org/10.1007/s00330-011-2349-2

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