3) showed a wedge-shaped hypointense area, as seen on non-enhanced CT, and T2-weighted images (Fig. An association between the occurrence of benign focal liver lesions and age was observed. At the time the article was created Matt A. Morgan had no recorded disclosures. ; Syrigos, K.N. Unable to process the form. Author to whom correspondence should be addressed. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. View Frank Gaillard's current disclosures, View Raymond Chieng's current disclosures, see full revision history and disclosures, World Health Organisation 2001 classification of hepatic hydatid cysts, recurrent pyogenic (Oriental) cholangitis, combined hepatocellular and cholangiocarcinoma, inflammatory myofibroblastic tumour (inflammatory pseudotumour), portal vein thrombosis (acute and chronic), cavernous transformation of the portal vein, congenital extrahepatic portosystemic shunt classification, congenital intrahepatic portosystemic shunt classification, transjugular intrahepatic portosystemic shunt (TIPS), transient hepatic attenuation differences (THAD), transient hepatic intensity differences (THID), total anomalous pulmonary venous return (TAPVR), hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease), cystic pancreatic mass differential diagnosis, pancreatic perivascular epithelioid cell tumour (PEComa), pancreatic mature cystic teratoma (dermoid), revised Atlanta classification of acute pancreatitis, acute peripancreatic fluid collection (APFC), hypertriglyceridaemia-induced pancreatitis, pancreatitis associated with cystic fibrosis, low phospholipid-associated cholelithiasis syndrome, diffuse gallbladder wall thickening (differential), focal gallbladder wall thickening (differential), ceftriaxone-associated gallbladder pseudolithiasis, biliary intraepithelial neoplasia (BilIN), intraductal papillary neoplasm of the bile duct (IPNB), intraductal tubulopapillary neoplasm (ITPN) of the bile duct, multiple biliary hamartomas (von Meyenburg complexes). The examinations were evaluated for the presence of a focal area of increased attenuation in the liver in locations where focal fatty sparing typically occurs: adjacent to the gallbladder fossa and in the medial segment of the left lobe near the porta hepatis. By definition, fatty sparing occurs in patients with diffuse fatty infiltration of the liver, which may be idiopathic or secondary to obesity, starvation, parenteral nutrition, steroid therapy, diabetes mellitus, alcohol, and hepatitis. Mechanistic review of drug-induced steatohepatitis. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. 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. Baseline and . The ultrasound results in a population of (n=45,319) hospital patients over a period of 10years were examined retrospectively and evaluated for the diagnosis of benign focal liver lesions [hepatic cysts, hepatic hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing]. All authors have read and agreed to the published version of the manuscript. analyzed and interpreted the data. Patients with focal fatty sparing are more often male and have a higher BMI and a larger liver than patients with nonalcoholic fatty liver disease without focal fatty sparing. NAFLD is considered the hepatic manifestation of metabolic syndrome and is associated with obesity, dyslipidemia, and type 2 diabetes mellitus. Gastroenterol Res Pract 2015:749235, Khosa F, Warraich H, Khan A, et al. Focal sparing in diffusely fatty liver is a well recognized entity. https://doi.org/10.3390/curroncol28040265, Lee MCM, Kachura JJ, Vlachou PA, Dzulynsky R, Di Tomaso A, Samawi H, Baxter N, Brezden-Masley C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. Patient consent was waived due to retrospective nature of the study. (d) In-phase MR images show a hypointense area in the entirely hyperintense liver (TR = 120, TE = 4.2). Studies concerning the prevalence of benign focal liver lesions present a quite heterogeneous picture as regards the precise research question posed, the size of the population studied, and the investigative methods used. Onaya et al. (2001) Incidence and significance of small focal liver lesions in MRI. He had undergone sigmoidectomy for well differentiated adenocarcinoma of the sigmoid colon on September 2, 1993 in our department. ; Dzulynsky, R.; Di Tomaso, A.; Samawi, H.; Baxter, N.; Brezden-Masley, C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. The role of statins in the management of nonalcoholic fatty liver disease. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Srensen, P.; Edal, A.; Madsen, E.; Fenger, C.; Poulsen, M.R. When located in characteristic locations then there is usually little difficulty in making the correct diagnosis. Our measured mean cyst size of 2.2cm corresponds to the values published in the literature [19, 22, 23, 30]. ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. Is hepatic steatosis reversible? ; Davila, J.A. Histological examination revealed that the tumor, a well differentiated adenocarcinoma, was surrounded by fibrotic tissue, and that this fibrotic tissue contained fewer fat vacuoles than the rest of the liver parenchyma (Fig. The gallbladder is a small, pear-shaped organ on the right side of the belly (abdomen), beneath the liver. The highest prevalence was found in younger women, and 86.4% (n=70) of all patients with FNH were females. ; Hanafi, I.; Al Zoubi, M.; Bdeir, Z.; Yassin, M.A. All ultrasonographic examinations were performed in the ultrasound unit by experienced physicians. The prevalence of FNH lies between 0.8% and 3.2% [1215], of hepatic adenoma from 0.4% to 1.5% [11, 12, 15, 16], and of focal fatty sparing between 7.2% and 19.8% [8, 17, 18]. 2005;14 (4): 419-25. Used criteria for the diagnosis of the lesions are presented in Table1. ; Rinella, M.; Sanyal, A.J. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients, https://doi.org/10.1007/s00261-015-0605-7, Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma, Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran, Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre, Application of new ultrasound techniques for focal liver lesions, Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules, Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography, Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability, Uncommon imaging evolutions of focal liver lesions in cirrhosis, Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art, http://creativecommons.org/licenses/by/4.0/. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. ; Mechanick, J.I. Alcoholic fatty liver may be accompanied by inflammation and necrosis (alcoholic hepatitis) and permanent damage in the form of cirrhosis. CT arteriography and dynamic magnetic resonance images were useful for diagnosing this metastatic tumor. The mean size was 39.0mm (Table3). Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. We thank Ayesha Taqi and Aftab Malik for their generous help in the data collection process. However, few reports described nodular . Find support for a specific problem in the support section of our website. Doumas, M.; Imprialos, K.; Dimakopoulou, A.; Stavropoulos, K.; Binas, A.; Athyros, V.G. In contrast, in-phase images showed a hypointense area in the entirely hyperintense liver (Fig. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas ().This condition, called focal sparing, can occur in . A total of 44.9% of these patients were outpatients and 55.1% inpatients. The second most commonly diagnosed liver lesion was the hepatic cyst, with 5.8% (n=2631). reported a higher prevalence of hepatic hemangioma in womenresulting that we were unable to corroborate with our data (Table3) [21, 29]. ; Katirtzoglou, N.A. Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. 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. Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. 1991;181 (3): 809-12. The authors declare no conflict of interest. Piscaglia, F.; Svegliati-Baroni, G.; Barchetti, A.; Pecorelli, A.; Marinelli, S.; Tiribelli, C.; Bellentani, S. HCC-NADFL Italian Study Group. CTAP showed a wedge-shaped ischemic area. - 208.97.158.245. Ultrasound Q 23:7980, Kester NL, Elmore SG (1995) Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. There appears to be some relationship between the high density around the gallbladder area and the fatty liver. Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. The treatment for ALD focuses on treating alcohol use disorder. Severe and Late Acute Liver Injury Induced by Capecitabine. reported a prevalence of 7.2% in a population of patients with colorectal carcinoma [17]. ; Saeian, K.; Lalehzari, M.; Aronsohn, A.; Gorospe, E.C. It is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. ; Guo, G.L. Data of 45,319 patients (48.5% women and 51.48% men) were analyzed using a PC-based, standardized documentation system (ViewPoint GE Healthcare GmbH Wessling/Oberpfaffenhofen, Germany). (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. PubMedGoogle Scholar. Hepatic steatosis secondary to capecitabine: A case report. If no unequivocal and/or acceptable statements about the above-mentioned parameters could be made from the re-inspected ultrasound images, these were expanded and/or measured again. (2012) Prevalence of non-cardiac pathology on clinical transthoracic echocardiography. Prevalence of benign focal liver lesions: ultrasound - Springer 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. 2001;177(5):1035-9. congenital malformations and anatomical variants. What does Focal fatty sparing is seen adjacent to the gallbladder fossa mean A 32-year-old male asked: Incidental observation of fatty liver with fatty sparing around the gallbladder fossa in ct trauma analysis? Rev Esp Enferm Dig 89:771780, Strunk H, Mildenberger P, Jonas J (1992) The incidence of focal liver lesions in patients with colorectal carcinoma. Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis. In comparison with CT, MRI, and autopsy studies, which show a far higher range of prevalence, our figure is in the lower third [10, 11, 19, 20]. (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. 2014;8(2):219-23. congenital malformations and anatomical variants. J Clin Pathol 39:183188, Article The dynamic contrast enhancement techniques, CTA and dynamic MR imaging, showed irregular enhancement in the abnormal area, which indicated disappearance of the normal vessel structure and was quite useful for diagnosing the metastatic tumor. Location. designed the study and conducted data collection. Google Scholar, Chiche L, Adam JP (2013) Diagnosis and management of benign liver tumors. 2021. The electronic medical records of these patients were reviewed. All lesions were examined also by color and power Doppler ultrasound. Ultraschall Med 31:3742, Varbobitis IC, Pappas G, Karageorgopoulos DE, Anagnostopoulos I, Falagas ME (2010) Decreasing trends of ultrasonographic prevalence of cystic echinococcosis in a rural Greek area. In order to be human-readable, please install an RSS reader. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). Eur J Radiol 83:930934, Marin D, Galluzzo A, Plessier A, et al. Focal sparing of liver parenchyma in steatosis: role of the gallbladder Here, we observed that there is a trend towards a higher rate of CAS development within one year of follow-up among stage IIIII CRC patients who received chemotherapy compared to the no treatment group. The liver tissue containes an abnormal number of fat vacuoles (upper left), while the fibrotic liver tissue adjacent to the well differentiated adenocarcinoma contains fewer fat vacuoles than the rest of the liver parenchyma. 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. 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. Google Scholar, Collin P, Rinta-Kiikka I, Rty S, Laukkarinen J, Sand J (2015) Diagnostic workup of liver lesions: too long time with too many examinations. The data are not publicly available due to patient privacy. ; Jastreboff, A.M.; Nadolsky, K.; Pessah-Pollack, R.; Plodkowski, R. Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. Ultrasound features only become apparent when the amount of fat reaches 15-20%. ; Petersen, O.F. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). The study was conducted in accordance with the Guidelines of the Declaration of Helsinki and the recommendations of Good Clinical Practice. Association between body mass index and fatty liver risk: A dose-response analysis. To date, only a few studies have been published on the prevalence of focal fatty sparing or of focal fat distribution disorders in the liver [8, 27]. Case 1: adenomyomatosis of the gallbladder - fundal, View Matt A. Morgan's current disclosures, see full revision history and disclosures, World Health Organization 2001 classification of hepatic hydatid cysts, recurrent pyogenic (Oriental) cholangitis, combined hepatocellular and cholangiocarcinoma, inflammatory myofibroblastic tumor (inflammatory pseudotumor), portal vein thrombosis (acute and chronic), cavernous transformation of the portal vein, congenital extrahepatic portosystemic shunt classification, congenital intrahepatic portosystemic shunt classification, transjugular intrahepatic portosystemic shunt (TIPS), transient hepatic attenuation differences (THAD), transient hepatic intensity differences (THID), total anomalous pulmonary venous return (TAPVR), hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease), cystic pancreatic mass differential diagnosis, pancreatic perivascular epithelioid cell tumor (PEComa), pancreatic mature cystic teratoma (dermoid), revised Atlanta classification of acute pancreatitis, acute peripancreatic fluid collection (APFC), hypertriglyceridemia-induced pancreatitis, pancreatitis associated with cystic fibrosis, low phospholipid-associated cholelithiasis syndrome, diffuse gallbladder wall thickening (differential), focal gallbladder wall thickening (differential), ceftriaxone-associated gallbladder pseudolithiasis, biliary intraepithelial neoplasia (BilIN), intraductal papillary neoplasm of the bile duct (IPNB), intraductal tubulopapillary neoplasm (ITPN) of the bile duct, multiple biliary hamartomas (von Meyenburg complexes), Differential diagnosis focal gallbladder wall thickening, 1. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas (1). However, it can occur in other parts of the liver and show various shapes including a wedge, as was seen in the present case (7). Such atypical cases may simulate neoplasms on CT scans (1,810). CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. Unfortunately, we cannot compare our results on age and gender distribution or those concerning the average size of the hepatic adenoma with any of the studies available to us. 4).MRI is very useful for making the diagnosis of focal hepatic steatosis, which appears isointense or hyperintense to liver on in-phase images and loses signal on out-of-phase images. After the operation, the patient suffered from severe jaundice and hyperammonemia. 4 and 5). Non-enhanced CT demonstrated a fatty liver associated with a wedge-shaped hyperdense area which occupied almost all of the anterior segment of the right lobe (Fig. Comparison of the study results is also difficult, because the studies differ with regard to the selection of the population investigated, the number of individuals investigated, and the diagnostic method used [ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) or autopsy]. Therefore, a fundamental knowledge of the prevalence and image morphology of hepatic hemangiomas, hepatic cysts, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing is essential. Fan, R.; Wang, J.; Du, J. Oncol. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). Hepatic toxicity associated with fluorouracil plus levamisole adjuvant therapy. Google Scholar, Buscarini E, Danesino C, Plauchu H, et al. The serum total bilirubin level rose to 19.9 mg/dl on the 11th postoperative day. In our study, this figure fell almost linearly with increasing age and amounted to only 66.8% in the group of patients over 70years of age. 1.1.11 Fatty liver and focal sparing | Ultrasound Cases Google Scholar, Kreft B, Pauleit D, Bachmann R, et al. 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). 4) clearly showed a wedge-shaped hypointese area in the anterior segment, suggesting ischemia in this area. Current Oncology. 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 [. 1, 2, 3 permission provided that the original article is clearly cited. Saif, M.W. 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. Focal fatty infiltration increases the echogenicity of the liver on US images and produces low attenuation on CT images. The youngest patient group, under 30years of age, was scarcely affected, with an age-specific prevalence of 0.8% (n=21). We investigated the potential association between adjuvant chemotherapy and the development of steatosis among patients with stage IIIII CRC. 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]. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. Serum electrolytes, blood urea nitrogen, creatinine, glucose, total bilirubin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), leucine aminopeptidase (LAP) and gamma-glutamyltranspeptidase (g-GTP) were all within the normal ranges. It is likely to have different pathogenesis than non-alcoholic steatohepatitis which is a diffuse process. 5). ; Gasbarrini, A.; Gasbarrini, G. Fatty liver and drugs. We recently experienced a case of liver metastasis from colon cancer which appeared as a wedge-shaped hyperdense area on non-enhanced CT (computed tomography). is there a problem of fatty lever? 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. Am J Clin Pathol 29:160162, Rungsinaporn K, Phaisakamas T (2008) Frequency of abnormalities detected by upper abdominal ultrasound. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. Eur J Radiol 54:388392, Vlk M, Strotzer M, Lenhart M, et al. Focal hepatic steatosis | Radiology Reference Article - Radiopaedia Hepatomegaly (enlarged liver): Symptoms, causes, and treatment Peppercorn, P.; Reznek, R.; Wilzon, P.; Slevin, M.L. Google Scholar, Sanfelippo P, Beahrs O, Weiland L (1974) Cystic disease of the liver. There are some case reports about this kind of tricks revealed by computed tomography (CT) and magnetic resonance imaging. Twelves, C.; Scheithauer, W.; McKendrick, J.; Seitz, J.F. 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. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. In relation to the CT, MRI, and autopsy studies, our prevalence is in the mid to lower third of the range. Focal fat deposition is slightly less common and can mimic other hepatic benign or malignant lesions on ultrasound and CT (Fig. Pathological examination revealed fibrotic liver tissue adjacent to the tumor; this fibrotic tissue contained fewer fat vacuoles than the rest of the liver parenchyma. Habib, M.B. From six or more foci upwards, these were combined as more than five lesions. The information about lesion size was based on the maximum measurable diameter in each case. There are only a few studies on the prevalence of FNH [1215]. J Ultrasound Med 14:7780, Karcaaltincaba M, Akhan O (2007) Imaging of hepatic steatosis and fatty sparing. Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. The age-dependent frequency of hepatic steatosis and the related prevalence of focal fatty sparing in patients with hepatic steatosis were also determined (Table2). permission is required to reuse all or part of the article published by MDPI, including figures and tables. Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. MRI exhibits the highest sensitivity for detecting hepatic lipid infiltration and can detect as little as 5% steatosis in the liver at a sensitivity of 76.790.0% and a specificity of 87.191% [, Another limitation of this study is the relatively small sample size, particularly for the cohort of patients receiving statins. It is therefore difficult to compare the various study results and apply them to routine ultrasound primary diagnostics. 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. (2010) Prevalence and risk factors of focal sparing in hepatic steatosis. The largest measured cyst diameter averaged 22.3mm. 1. Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. An assessment of the safety and efficacy of statins in a randomized controlled cohort will allow for an accurate investigation into this phenomenon that contributes to a secondary health burden for the curative CRC patient population. ; Kachura, J.J.; Vlachou, P.A. You are accessing a machine-readable page.
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