methods, instructions or products referred to in the content. 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. 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. PubMed At the time the article was created Frank Gaillard had no recorded disclosures. Epidemiology Our result of 6.3% is below the prevalence figures of Kratzer et al. Alkhouri, N. NASH and NAFLD: Emerging drugs, therapeutic targets and translational and clinical challenges. ; Kachura, J.J.; Vlachou, P.A. ; Hurley, D.L. Canadian Cancer Societys Advisory Committee on Cancer Statistics. most exciting work published in the various research areas of the journal. Furthermore, there is currently a lack of medical treatment for any population affected by steatosis, regardless of etiology, although a recently published population-based study suggests that statins may confer protective benefits against the development of steatosis. Focal sparing shows oppsite patterns on US and CT: decreased echogenicity on US images and high attenuation on CT images. ; Brett, E.M.; Garber, A.J. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Alcoholic fatty liver may be accompanied by inflammation and necrosis (alcoholic hepatitis) and permanent damage in the form of cirrhosis. (2010) Prevalence and risk factors of focal sparing in hepatic steatosis. In the case of hepatic cysts, the range of prevalence figures from CT, MRI, or autopsy studies is also much wider than that of the ultrasound-based studies [5, 10, 15, 19, 30]. The data presented in this study are available on request from the corresponding author. ; Foley, W.D. It was suggested that the tumor caused this ischemia due to intrahepatic portal vein blockade. 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. Focal hepatic steatosis | Radiology Reference Article - Radiopaedia Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis. 3) showed a wedge-shaped hypointense area, as seen on non-enhanced CT, and T2-weighted images (Fig. It may include one or more of the following: supervised medical detox behavioral therapies, such as cognitive behavioral therapy or. 377/13). Check for errors and try again. Current Oncology | Free Full-Text | Evaluation of Adjuvant Chemotherapy is fatty lever curable? 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. Moreover, there is evidence to believe that larger, higher power studies should be conducted to further investigate the protective benefits of statins in reducing the risk of CAS, owing to the mild reduction in the adjusted relative risk of steatosis in statin users observed in the present study. This difference can be related to the population size and age of the patients studied [13, 14]. 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. These segments were rarely spared in patients with previous cholecystectomy. Close Figure Viewer Return to Figure Previous FigureNext Figure Among various candidate drugs under investigation, statins have been considered as a potential therapeutic option, and were recently shown to effectively reduce the risk of NAFLD development in a large population-based study [, Colorectal cancer (CRC) consistently ranks as one of the leading causes of cancer-related deaths in Canada [. Of 269 patients, 76 (28.3%) had steatosis at baseline. The remaining 193 patients who did not have fatty liver at baseline were further divided by whether they received curative chemotherapy (, The characteristics of the two patient groups are outlined in, We found that 52 of 135 patients (38.5%) who received adjuvant chemotherapy developed steatosis within one year of follow-up, compared to 14 of 58 patients (24.1%) who did not receive chemotherapy (Relative Risk [RR] 1.57, 95% confidence interval [CI] 0.89 to 2.79) after adjustment for sex, BMI, type 2 diabetes mellitus, hyperlipidemia, and steroid use. J Clin Ultrasound 21:115118, Gaines PA, Sampson MA (1989) The prevalence and characterization of simple hepatic cysts by ultrasound examination. Semin Liver Dis 33:236247, Article It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Andr, T.; Boni, C.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Bonetti, A.; Clingan, P.; Bridgewater, J.; Rivera, F.; et al. World J Gastroenterol 19:31733188, Article Based on the results of our study, it is necessary to conduct prospective studies that involve a larger cohort of patients, who are controlled for comorbidities that may confound the association between CRC, statin use and the incidence of steatosis. 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. Rofo 156:325327, Koseoglu K, Ozsunar Y, Taskin F, Karaman C (2005) Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. Baseline and . Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. Editors select a small number of articles recently published in the journal that they believe will be particularly Men were affected much more often (63.5%) than women (36.5%). 2). Doumas, M.; Imprialos, K.; Dimakopoulou, A.; Stavropoulos, K.; Binas, A.; Athyros, V.G. Women were somewhat more affected (56.1%, n=1477) than men (43.9%, n=1154). In addition, many studies on the prevalence of benign space-occupying lesions of the liver were conducted in the 1990s or earlier, i.e., at a time when the image quality of the ultrasound devices used was greatly inferior [17, 2123]. Out of the 269 patients deemed eligible for analysis, 76 (28.3%) had fatty liver at baseline imaging, prior to treatment with adjuvant chemotherapy. In relation to the CT, MRI, and autopsy studies, our prevalence is in the mid to lower third of the range. 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. For example, the prevalence of hepatic hemangioma determined in the studies ranged from 0.1% to 20.0% and that of hepatic cysts from 0.06% to 17.8%. methicillin-resistant Staphylococcus aureus, Oxford University Press is a department of the University of Oxford. (2001) Incidence and significance of small focal liver lesions in MRI. In patients with an intact gallbladder, segments 4 and 5 were spared most often. Case 19 - Nodular focal fatty sparing of the liver - Cambridge Core 1. The number of focal lesions was considered separately up to a figure of five lesions. 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. 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. Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. Grieco, A.; Forgione, A.; Miele, L.; Greco, A.V. reported a higher prevalence of hepatic hemangioma in womenresulting that we were unable to corroborate with our data (Table3) [21, 29]. At least one of the lesions of interest was found in a total of 6851 patients (15.1% of the population examined). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Findings and Implications of Focal Fatty Sparing of the Liver at Follow Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. Patient characteristics including sex, age at diagnosis, and Body Mass Index (BMI), as well as baseline comorbidities including type 2 diabetes mellitus, hyperlipidemia, and hypertension, were collected. Opposed-phase images showed a hyperintense area in the entirely hypointense liver (Fig. Detection of Hepatic Steatosis on Contrast-Enhanced CT Images All articles published by MDPI are made immediately available worldwide under an open access license. Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. Multiple FNHs were rare; the prevalence of solitary FNHs was 88.9% (n=72), and the average size was 51.6mm. 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. Abbreviations: BMI (Body Mass Index). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. The finding of a FNH or an adenoma is rarely a fortuitous result. Focal fatty sparing of the liver is the localized absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. The CEA level was 15.1 ng/ml and the cancer antigen 199 (CA199) level 167.4 U/ml. Google Scholar, Linhart P, Bnhof JA, Baqu PE, Pering C (1998) Ultrasound in diagnosis of benign and malignant liver tumors. What does focal fatty sparing of the liver mean? - Studybuff HPB (Oxford) 7:186196, Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany, Tanja Eva-Maria Kaltenbach,Phillip Engler,Wolfgang Kratzer,Suemeyra Oeztuerk,Thomas Seufferlein&Mark Martin Haenle, Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany, Zentraler Ultraschall, Klinik fr Innere Medizin I, Zentrum fr Innere Medizin, Universittsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany, You can also search for this author in Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously) focal fatty infiltration , represents small areas of liver steatosis. The relative risk of developing steatosis was not significantly different regardless of statin therapy status at the time of adjuvant chemotherapy (RR 0.45, 95% CI 0.10 to 2.75) after adjusting for sex, BMI, type 2 diabetes mellitus, and hyperlipidemia (, In the present study, the adjusted relative risk of adjuvant chemotherapy reflected a moderately increased risk of steatosis, although the confidence intervals were wide. In terms of the abnormal finding in the anterior segment, non-enhanced CT suggested focal sparing and sonography suggested a metastatic tumor. J Med Assoc Thai 91:10721075, PubMed J Clin Pathol 39:183188, Article The project received a positive opinion from the local ethics committee (No. Through higher performance ultrasound equipment and the introduction of contrast-enhanced ultrasound, the diagnosis of FNH can nowadays be made with higher sensitivity and specificity [31]. ; Laurie, J.A. Recently, some reports have mentioned the appearance of a focal sparing area in the generalized fatty liver. A Feature A chest X-ray on admission showed no abnormality. In the past 10years, comparatively few ultrasound-based studies have appeared on this subject [69]. ; Tanimoto, A.; Baba, Y.; Zhao, L.; Chen, J.; Middleton, M.S. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). 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%. Gut Liver. It was suggested that this fibrotic liver tissue corresponded to the area of focal sparing seen on CT and MR images. Gastroenterol Res Pract 2015:749235, Khosa F, Warraich H, Khan A, et al. Become a Gold Supporter and see no third-party ads. ; Tomlinson, J.W. Eur J Radiol 83:930934, Marin D, Galluzzo A, Plessier A, et al. Wolfgang Dhnert. Visit our dedicated information section to learn more about MDPI. On the liver ultrasonography, the liver showed increased echogenicity suggestive of fatty liver grade 2. We often found a high attenuation region around the gallbladder bed in the fatty liver patients on CT examination. 1. We use cookies on our website to ensure you get the best experience. Hepatology 50:481489, Thapar M, Grapp O, Fisher C (2015) Management of hepatic adenomatosis. Lawrence, D.A. There are some case reports about this kind of tricks revealed by computed tomography (CT) and magnetic resonance imaging. ; Charlton, M. Changes in the Prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Moreover, his temperature rose to 39 C on the 5th postoperative day, and methicillin-resistant Staphylococcus aureus (MRSA) was detected in his blood. The term 'fatty infiltration of the liver' is often erroneously used to describe liver steatosis. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin and adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. PubMed Central The finding of a FNH or an adenoma is rarely a random discovery. ; Gupta, R.K. Is hepatic steatosis reversible? ; Mechanick, J.I. Multiple requests from the same IP address are counted as one view. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. There are no ultrasound studies on the prevalence of hepatic adenoma within a large patient population. Fatty sparing - what is it? | Liver Problems | Forums | Patient (2016) Seminars in ultrasound, CT, and MR. 37 (6): 501-510. In contrast, in-phase images showed a hypointense area in the entirely hyperintense liver (Fig. ; Dobbins, R.; Nuremberg, P.; Horton, J.D. Check for errors and try again. Chemotherapy-associated steatosis is pathologically indistinguishable from NAFLD, which has a benign onset as simple hepatic steatosis, but can asymptomatically progress to steatohepatitis [, Despite these risks, current treatment for hepatic steatosis is limited to changes in lifestyle to mitigate cardiovascular risk factors [, In this study, the primary mode of determining steatosis status in patients included a review of the medical records and the abdominal images (CT, ultrasound and MRI) by a single radiologist. ; MacFarlane, P.W. Del pilar fernandez M, Bernardino ME. future research directions and describes possible research applications. Association between body mass index and fatty liver risk: A dose-response analysis. ; Kramer, J.R.; Richardson, P.A. Tanja Eva-Maria Kaltenbach and Phillip Engler have contributed equally to this work. Ultrasound results typical of adenomas and FNH were only included in the evaluation, if these had been confirmed by further imaging or histology. ; McKillop, J.H. 3. When located in characteristic locations then there is usually little difficulty in making the correct diagnosis. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). 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. The role of statins in the management of nonalcoholic fatty liver disease. 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. Two further examinations were therefore performed to distinguish between these two types of lesion. Kratzer et al. Simple hepatic cysts and hemangiomas are the most common focal liver lesions. In the absence of studies exploring the role of statin therapy in chemotherapy-associated steatosis (CAS), we speculated that the protective benefit of statins in fatty liver at large may translate to prevention of CAS among patients who are receiving statins at the time of their chemotherapy. Introduction. Wolfgang Kratzer. The highest prevalence figures were reported from autopsy and CT studies [12, 15, 19, 28]. No special 1); enhanced CT was not done. Current status of imaging in nonalcoholic fatty liver disease. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Radiology. Patients with polycystic liver diseases were excluded from this study. Geographic focal fat sparing, much like focal fat infiltration involves similar areas: gallbladder fossa, medial segment near the falciform ligament, and the porta hepatis (Fig 4 a).Nodular focal fat sparing presents as hypoechoic lesions in a diffusely echogenic liver and can be extremely difficult to differentiate from true mass lesions (Fig 4 b). ; Reif, L.J. Although these four sequences suggested focal sparing, dynamic MR images clearly showed irregular enhancement in the abnormal area of the anterior segment, suggesting a metastatic tumor (image not shown). We thank Ayesha Taqi and Aftab Malik for their generous help in the data collection process. PubMedGoogle Scholar. In our study cohort, we did not observe a significant difference in the risk of developing steatosis when comparing patients receiving oxaliplatin-containing chemotherapy compared to those on a 5-FU based regimen (RR 0.64, 95% CI 0.30 to 1.38) after adjusting for sex, BMI, type 2 diabetes mellitus, hyperlipidemia, and steroid use (, The demographics of 135 patients who were treated with chemotherapy were summarized based on statin administration status, shown in, Among patients who were on statins at the time of their adjuvant chemotherapy, 11 of 37 (29.7%) patients developed steatosis within one year; however, 41 of 98 (41.8%) patients who did not receive statin treatment developed steatosis. The data are not publicly available due to patient privacy. Mechanisms of NAFLD development and therapeutic strategies. PubMed Central Kim B, Oh J, Nam K et al. With our determined prevalence of 5.8%, we are also here in the mid-range. In order to demonstrate differences between patients with and without a lesion, the Wilcoxon signed rank-sum test was applied for continuous variables and the no financial relationships to ineligible companies to disclose. The investigating physician is therefore increasingly faced with the problem of differentiating between malignant and benign space-occupying processes and of distinguishing the various lesions from each other [24]. Apart from 2 exceptions, all diagnosed adenomas were solitary findings (89.5%, n=17). The frequency of focal fatty sparing in patients with hepatic steatosis decreased with age and in the youngest age group of patients with hepatic steatosis, namely under 30years of age, the specific prevalence of focal fatty sparing was over 90%. 84.2% (n=16) of patients with adenoma were women. What does Focal fatty sparing is seen adjacent to the gallbladder fossa Kaltenbach, T.EM., Engler, P., Kratzer, W. et al. In this study, Stage II-III 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. AJR Am J Roentgenol 162:11191122, Article Lee, J.I. Location. 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. in 2005, there has been some research on the association between steatosis and anti-tumour drugs, although the precise impacts of CRC chemotherapy have largely been unexplored. Terminology Between 01/2003 and 11/2013, the liver was examined by ultrasound in a total of 45,319 patients, of whom 48.5% were women (n=21,988) and 51.48% men (n=23331). Diagnosis of focal hepatic lesions is therefore often difficult in patients with fatty infiltration. As also found by Aubin et al., one possible cause could be the lower clustering of focal fatty sparing in patients with status post cholecystectomy, whose number increases with age and occurs more frequently in a hospital population than in a random sample of the entire population [24]. Focal Fatty Sparing Usually Does Not Arise in Preexisting Nonalcoholic
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