Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 8/2019

01-08-2019 | Gastrointestinal

CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: development and validation of diagnostic cut-off values in a large cohort with pathological reference standard

Authors: Jieun Byun, Seung Soo Lee, Yu Sub Sung, Youngbin Shin, Jessica Yun, Ho Sung Kim, Eun sil Yu, Sung-Gyu Lee, Moon-gyu Lee

Published in: European Radiology | Issue 8/2019

Login to get access

Abstract

Objectives

To compare the performances of CT indices for diagnosing hepatic steatosis (HS) and to determine and validate the CT index cut-off values.

Methods

Three indices were measured on non-enhanced CT images of 4413 living liver donor candidates (2939 men, 1474 women; mean age, 31.4 years): hepatic attenuation (CTL), hepatic attenuation minus splenic attenuation (CTL-S), and hepatic attenuation divided by splenic attenuation (CTL/S). The performances of these CT indices in diagnosing HS, relative to pathologic diagnosis, were compared in the development cohort of 3312 subjects by receiver operating characteristic (ROC) analysis. The cut-off values for diagnosing HS > 33% in the development cohort were determined at 95% specificity and 95% sensitivity using bootstrap ROC analysis, and the diagnostic performance of these cut-off values was validated in the test cohort of 1101 subjects.

Results

CTL-S showed the highest performance for diagnosing HS ≥ 5% and HS > 33% (areas under the curve (AUCs) = 0.737 and 0.926, respectively), followed by CTL/S (AUCs = 0.732 and 0.925, respectively) and CTL (AUCs = 0.707 and 0.880, respectively). For CT scans using 120 kVp, the CTL-S cut-off values for highly specific (i.e., − 2.1) and highly sensitive (i.e., 7.6) diagnosis of HS > 33% resulted in a specificity of 96.4% with a sensitivity of 64.0% and a sensitivity of 97.3% with a specificity of 54.9%, respectively, in the test cohort.

Conclusion

CT indices using liver and spleen attenuations have higher performance for diagnosing HS than indices using liver attenuation alone. The CTL-S cut-off values in this study may have utility for diagnosing HS in clinical practice and research.

Key Points

• CT indices based on both liver attenuation and spleen attenuation (CTL-Sand CTL/S) have higher diagnostic performance than CTLbased on liver attenuation alone in diagnosing HS using various CT techniques.
• The CT index cut-off values determined in this study can be utilized for reliable diagnosis or to rule out subjects with moderate to severe HS in clinical practice and research, including the selection of living liver donors and the development of cohorts with HS or healthy controls.
Appendix
Available only for authorised users
Literature
1.
Teli MR, James OF, Burt AD, Bennett MK, Day CP (1995) The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 22:1714–1719CrossRefPubMed
2.
de Alwis NM, Day CP (2008) Non-alcoholic fatty liver disease: the mist gradually clears. J Hepatol 48(Suppl 1):S104–S112CrossRefPubMed
3.
Adams LA, Sanderson S, Lindor KD, Angulo P (2005) The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 42:132–138CrossRefPubMed
4.
Ascha MS, Hanouneh IA, Lopez R, Tamimi TA, Feldstein AF, Zein NN (2010) The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 51:1972–1978CrossRefPubMed
5.
Korenblat KM, Fabbrini E, Mohammed BS, Klein S (2008) Liver, muscle, and adipose tissue insulin action is directly related to intrahepatic triglyceride content in obese subjects. Gastroenterology 134:1369–1375CrossRefPubMed
6.
Gastaldelli A, Kozakova M, Højlund K et al (2009) Fatty liver is associated with insulin resistance, risk of coronary heart disease, and early atherosclerosis in a large European population. Hepatology 49:1537–1544CrossRefPubMed
7.
Marsman WA, Wiesner RH, Rodriguez L et al (1996) Use of fatty donor liver is associated with diminished early patient and graft survival. Transplantation 62:1246–1251CrossRefPubMed
8.
Takyar V, Nath A, Beri A, Gharib AM, Rotman Y (2017) How healthy are the “healthy volunteers”? Penetrance of NAFLD in the biomedical research volunteer pool. Hepatology 66:825–833CrossRefPubMed
9.
10.
Lee SS, Park SH, Kim HJ et al (2010) Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol 52:579–585CrossRefPubMed
11.
Boyce CJ, Pickhardt PJ, Kim DH et al (2010) Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT. AJR Am J Roentgenol 194:623–628CrossRefPubMed
12.
Hahn L, Reeder SB, Muñoz del Rio A, Pickhardt PJ (2015) Longitudinal changes in liver fat content in asymptomatic adults: hepatic attenuation on unenhanced CT as an imaging biomarker for steatosis. AJR Am J Roentgenol 205:1167–1172CrossRefPubMedPubMedCentral
13.
Iwasaki M, Takada Y, Hayashi M et al (2004) Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 78:1501–1505CrossRefPubMed
14.
Kan H, Kimura Y, Hyogo H et al (2014) Non-invasive assessment of liver steatosis in non-alcoholic fatty liver disease. Hepatol Res 44:E420–E427CrossRefPubMed
15.
Limanond P, Raman SS, Lassman C et al (2004) Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings. Radiology 230:276–280CrossRefPubMed
16.
Park SH, Kim PN, Kim KW et al (2006) Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology 239:105–112CrossRefPubMed
17.
Park YS, Park SH, Lee SS et al (2011) Biopsy-proven nonsteatotic liver in adults: estimation of reference range for difference in attenuation between the liver and the spleen at nonenhanced CT. Radiology 258:760–766CrossRefPubMed
18.
Pickhardt PJ, Park SH, Hahn L, Lee SG, Bae KT, Yu ES (2012) Specificity of unenhanced CT for non-invasive diagnosis of hepatic steatosis: implications for the investigation of the natural history of incidental steatosis. Eur Radiol 22:1075–1082CrossRefPubMed
19.
Piekarski J, Goldberg HI, Royal SA, Axel L, Moss AA (1980) Difference between liver and spleen CT numbers in the normal adult: its usefulness in predicting the presence of diffuse liver disease. Radiology 137:727–729CrossRefPubMed
20.
Rogier J, Roullet S, Cornélis F et al (2015) Noninvasive assessment of macrovesicular liver steatosis in cadaveric donors based on computed tomography liver-to-spleen attenuation ratio. Liver Transpl 21:690–695CrossRefPubMed
21.
Mellinger JL, Pencina KM, Massaro JM et al (2015) Hepatic steatosis and cardiovascular disease outcomes: an analysis of the Framingham Heart Study. J Hepatol 63:470–476CrossRefPubMedPubMedCentral
22.
Pickhardt PJ, Hahn L, Muñoz del Rio A, Park SH, Reeder SB, Said A (2014) Natural history of hepatic steatosis: observed outcomes for subsequent liver and cardiovascular complications. AJR Am J Roentgenol 202:752–758CrossRefPubMed
23.
Hong HC, Hwang SY, Choi HY et al (2014) Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study. Hepatology 59:1772–1778CrossRefPubMed
24.
Puchner SB, Lu MT, Mayrhofer T et al (2015) High-risk coronary plaque at coronary CT angiography is associated with nonalcoholic fatty liver disease, independent of coronary plaque and stenosis burden: results from the ROMICAT II trial. Radiology 274:693–701CrossRefPubMed
25.
Bae JC, Lee WY, Yoon KH et al (2015) Improvement of nonalcoholic fatty liver disease with Carnitine-Orotate Complex in Type 2 Diabetes (CORONA): a randomized controlled trial. Diabetes Care 38:1245–1252CrossRefPubMed
26.
27.
Kleiner DE, Brunt EM, Van Natta M et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41:1313–1321CrossRefPubMed
28.
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefPubMed
29.
Kodama Y, Ng CS, Wu TT et al (2007) Comparison of CT methods for determining the fat content of the liver. AJR Am J Roentgenol 188:1307–1312CrossRefPubMed
30.
Kaul A, Bauer B, Bernhardt J, Nosske D, Veit R (1997) Effective doses to members of the public from the diagnostic application of ionizing radiation in Germany. Eur Radiol 7:1127–1132CrossRefPubMed
31.
Nakayama Y, Awai K, Funama Y et al (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 237:945–951CrossRefPubMed
32.
Tran TT, Changsri C, Shackleton CR et al (2006) Living donor liver transplantation: histological abnormalities found on liver biopsies of apparently healthy potential donors. J Gastroenterol Hepatol 21:381–383CrossRefPubMed
Metadata
Title
CT indices for the diagnosis of hepatic steatosis using non-enhanced CT images: development and validation of diagnostic cut-off values in a large cohort with pathological reference standard
Authors
Jieun Byun
Seung Soo Lee
Yu Sub Sung
Youngbin Shin
Jessica Yun
Ho Sung Kim
Eun sil Yu
Sung-Gyu Lee
Moon-gyu Lee
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5905-1

Other articles of this Issue 8/2019

European Radiology 8/2019 Go to the issue

Breast

Effect of training on ultrasonography (US) BI-RADS features for radiology residents: a multicenter study comparing performances after training

Neuro

Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

Interventional

Comparison between the application of microcoil and hookwire for localizing pulmonary nodules

Nuclear Medicine

Integrated analysis of 18F-FDG PET/CT improves preoperative lymph node staging for patients with invasive bladder cancer

Musculoskeletal

Whole-body MRI to assess bone involvement in prostate cancer and multiple myeloma: comparison of the diagnostic accuracies of the T1, short tau inversion recovery (STIR), and high b-values diffusion-weighted imaging (DWI) sequences

Computed Tomography

Identifying perfusion deficits on CT perfusion images using temporal similarity perfusion (TSP) mapping