Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment.

PURPOSE To determine prospectively the diagnostic performance of unenhanced computed tomography (CT) in the assessment of macrovesicular steatosis in potential donors for living donor liver transplantation by using same-day biopsy as a reference standard. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. A total of 154 candidates, including 104 men (mean age, 30.2 years +/- 10.3 [standard deviation]) and 50 women (mean age, 31.8 years +/- 11.2), underwent same-day unenhanced CT and ultrasonography-guided liver biopsy. Histologic degree of macrovesicular steatosis was determined. Three liver attenuation indices were derived: liver-to-spleen attenuation ratio (CT(L)(/S)), difference between hepatic and splenic attenuation (CT(L)(-S)), and blood-free hepatic parenchymal attenuation (CT(LP)). Regression equations were used to quantitatively estimate the degree of macrovesicular steatosis. Limits of agreement between estimated macrovesicular steatosis and the reference standard were calculated. Receiver operating characteristic analyses were used to determine the performance of each index for qualitative diagnosis of macrovesicular steatosis of 30% or greater. The cutoff value that provided a balance between sensitivity and specificity and the highest cutoff value that yielded 100% specificity were determined. RESULTS Limits of agreement were -14% to 14% for CT(L)(/S) and CT(L)(-S) and -13% to 13% for CT(LP). Performance in diagnosing macrovesicular steatosis of 30% or greater was not significantly different among indices (P > .05). Cutoff values of 0.9, -7, and 58 were determined for CT(L)(/S), CT(L)(-S), and CT(LP), respectively, and provided a balance between sensitivity and specificity. Cutoff values of 0.8, -9, and 42 were determined for CT(L)(/S), CT(L)(-S), and CT(LP), respectively, and yielded 100% specificity for all indices, with corresponding sensitivities of 82%, 82%, and 73% for CT(L)(/S), CT(L)(-S), and CT(LP), respectively. CONCLUSION Diagnostic performance of unenhanced CT for quantitative assessment of macrovesicular steatosis is not clinically acceptable. Unenhanced CT, however, provides high performance in qualitative diagnosis of macrovesicular steatosis of 30% or greater.

[1]  Ja-june Jang,et al.  The hepatic regeneration power of mild steatotic grafts is not impaired in living‐donor liver transplantation , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[2]  P. Clavien,et al.  Understanding the meaning of fat in the liver , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[3]  Minoru Iwasaki,et al.  Noninvasive Evaluation of Graft Steatosis in Living Donor Liver Transplantation , 2004, Transplantation.

[4]  S. Jang,et al.  The effect of donor weight reduction on hepatic steatosis for living donor liver transplantation , 2004, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[5]  K. Sugimachi,et al.  Use of steatotic graft in living-donor liver transplantation , 2003, Transplantation.

[6]  Chih-Che Lin,et al.  Evaluation of living liver donors1 , 2003, Transplantation.

[7]  C. Wai,et al.  Pitfalls in interpreting liver biopsy results: The story of the blind men and the elephant , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[8]  C. Ryan,et al.  One hundred consecutive hepatic biopsies in the workup of living donors for right lobe liver transplantation , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[9]  P. Friend,et al.  Current practice regarding the use of fatty livers: A Trans‐Atlantic survey , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[10]  M. Rizzetto,et al.  Effect of macrovescicular steatosis and other donor and recipient characteristics on the outcome of liver transplantation , 2001, Clinical transplantation.

[11]  E. Moreno gonzález,et al.  An approach to the rational use of steatotic donor livers in liver transplantation. , 1999, Hepato-gastroenterology.

[12]  S. Uemoto,et al.  Effects of fatty infiltration of the graft on the outcome of living-related liver transplantation. , 1999, Transplantation proceedings.

[13]  J. Buckels,et al.  Impact of donor liver microvesicular steatosis on the outcome of liver retransplantation. , 1999, Transplantation proceedings.

[14]  M A Ureña,et al.  Assessing risk of the use of livers with macro and microsteatosis in a liver transplant program. , 1998, Transplantation proceedings.

[15]  D. Sautereau,et al.  Dual-energy CT in the diagnosis and quantification of fatty liver: limited clinical value in comparison to ultrasound scan and single-energy CT, with special reference to iron overload. , 1998, Journal of hepatology.

[16]  O. Smiseth,et al.  Regulation of hepatic vascular volume: contributions from active and passive mechanisms during catecholamine and sodium nitroprusside infusion. , 1997, Circulation.

[17]  T. Fishbein,et al.  Use of livers with microvesicular fat safely expands the donor pool. , 1997, Transplantation.

[18]  L Dalla Palma,et al.  Noninvasive in vivo quantitative assessment of fat content in human liver. , 1997, Journal of hepatology.

[19]  M. Stegall,et al.  Risk factors for primary dysfunction after liver transplantation--a multivariate analysis. , 1993, Transplantation.

[20]  S. Knechtle,et al.  The predictive value of donor liver biopsies for the development of primary nonfunction after orthotopic liver transplantation. , 1991, Transplantation.

[21]  T. Livraghi,et al.  Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies. , 1990, Journal of hepatology.

[22]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[23]  S. Saji,et al.  Quantitative evaluation of fatty liver by computed tomography in rabbits. , 1984, AJR. American journal of roentgenology.

[24]  J. Hanley,et al.  A method of comparing the areas under receiver operating characteristic curves derived from the same cases. , 1983, Radiology.

[25]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[26]  James Sayre,et al.  Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. , 2004, Radiology.

[27]  Z. Gao,et al.  Quantitative Diagnosis of Fatty Liver With Dual-Energy CT , 2003 .