Preoperative Radiographic Assessment of Hepatic Steatosis... : Journal of the American College of Surgeons (original) (raw)

Original scientific article

Preoperative Radiographic Assessment of Hepatic Steatosis with Histologic Correlation

Cho, Clifford S. MDa,*; Curran, Sean MDb; Schwartz, Lawrence H. MDb; Kooby, David A. MDf; Klimstra, David S. MDc; Shia, Jinru MDc; Munoz, Alejandro MDa; Fong, Yuman MD, FACSd; Jarnagin, William R. MD, FACSe; DeMatteo, Ronald P. MD, FACSe; Blumgart, Leslie H. MD, FACSe; D'Angelica, Michael I. MD, FACSe

From the aDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; bDepartment of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; cDepartment of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY; dGastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, NY; eHepatobiliary Service, Memorial Sloan-Kettering Cancer Center, New York, NY; fDivision of Surgical Oncology, Emory University Medical Center, Atlanta, GA.

*Correspondence address: Clifford S Cho, MD, Department of Surgery, Section of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, H4/724 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-7375.

Received June 12, 2007; Revised August 24, 2007; Accepted August 27, 2007.

Competing Interests Declared: None.

Abstract

BACKGROUND:

The adverse impact of hepatic steatosis on perioperative outcomes after liver resection is gaining recognition. But the accuracy of preoperative radiologic assessment of fatty liver disease remains unclear. The objective of this study was to correlate preoperative radiologic estimation with postoperative histologic measurement of steatosis.

STUDY DESIGN:

Patients who underwent partial hepatectomy between 1997 and 2001, with complete preoperative radiographic imaging and postoperative pathologic assessment of steatosis, were retrospectively analyzed. The presence of steatosis was assessed radiographically using noncontrast-enhanced CT (NCCT), contrast-enhanced CT (CCT), or MRI, using standard quantitative radiologic criteria. Repeat histologic analysis was used to quantify the extent of hepatic steatosis.

RESULTS:

One hundred thirty-one patients were studied. The overall sensitivity and specificity for all imaging modalities in detecting pathologically confirmed hepatic steatosis were 56% and 82%, respectively. Sensitivity and specificity for NCCT, CCT, and MRI using standard quantitative criteria were 33% and 100%, 50% and 83%, and 88%, and 63%, respectively. Increasing body mass indices adversely affected the accuracy of NCCT (p = 0.002). Preoperative chemotherapy did not notably affect radiologic accuracy.

CONCLUSIONS:

The presence of a fatty-appearing liver on NCCT scans indicates clinically significant steatosis, but steatosis cannot be excluded based on a normal NCCT scan, particularly in obese patients. Conversely, normal MRI helps to exclude hepatic steatosis, but abnormal MRI is not a reliable indicator of fatty change. CCT is not an effective means of identifying steatosis. We conclude that, when used alone, conventional cross-sectional imaging does not consistently permit accurate identification of hepatic steatosis.