On the liver ultrasonography, the liver showed increased echogenicity suggestive of fatty liver grade 2. 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). With our determined prevalence of 5.8%, we are also here in the mid-range. ; Dobbins, R.; Nuremberg, P.; Horton, J.D. A Feature Features include: inability to visualise the portal vein walls (as the parenchyma is as bright as the wall), decreases by 1.6 HU per mg of fat in each gram of liver, liver and spleen should normally be similar on delayed (70 seconds) scans, earlier scans are unreliable as the spleen enhances earlier than the liver (systemic supply rather than portal), MRI is the imaging modality of choice in any case where the diagnosis is felt to be less than certain. The level of significance was set at =5%, and the p value was given to four decimal places. For more information, please refer to and C.B.-M. contributed to the conception and design of the study. 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. Become a Gold Supporter and see no third-party ads. The role of statins in the management of nonalcoholic fatty liver disease. most exciting work published in the various research areas of the journal. The presence of this finding was considered evidence of diffuse hepatic steatosis. This study was also limited in that many potentially useful clinical and demographic data such as duration of statin administration and lifestyle factors contributory to steatosis could not be collected due to the retrospective nature of the investigation. Pastori, D.; Polimeni, L.; Baratta, F.; Pani, A.; Del Ben, M.; Angelico, F. The efficacy and safety of statins for the treatment of non-alcoholic fatty liver disease. At surgery, the tumor was found to be exposed on the surface of the anterior segment, adjoining not the middle hepatic vein but the right hepatic vein. A chest X-ray on admission showed no abnormality. - 208.97.158.245. ; Reif, L.J. Our measured mean cyst size of 2.2cm corresponds to the values published in the literature [19, 22, 23, 30]. Sigler, M.A. 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%. Ultrasound Q 23:7980, Kester NL, Elmore SG (1995) Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. The prevalence figures of the two ultrasound-based studies for FNH were 0.8% and 1.8% and lie below the figures of between 1.8% and 3.2% reported from CT, MRI, or pathological investigations [1215]. The electronic medical records of these patients were reviewed. The data are not publicly available due to patient privacy. the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. https://doi.org/10.3390/curroncol28040265, Lee, Michelle C. M., Jacob J. Kachura, Paraskevi A. Vlachou, Raissa Dzulynsky, Amy Di Tomaso, Haider Samawi, Nancy Baxter, and Christine Brezden-Masley. Shepherd, J.; Cobbe, S.; Ford, I.; Isles, C.G. 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. ; Guo, G.L. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Mittal, S.; El-Serag, H.B. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. The understanding of hepatic adenoma has changed fundamentally in recent years [32, 33]. A 62-year-old, slightly obese man was referred to us on April 12, 1996 because of suspected liver metastasis. Part of Springer Nature. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Although standard MR sequences are less helpful for visualization and characterization of fatty infiltration, chemical shift images (opposed- and in-phase images) are quite useful for depicting fat distribution and assist the diagnosis of focal fatty infiltration or sparing (7). Rev Esp Enferm Dig 89:771780, Strunk H, Mildenberger P, Jonas J (1992) The incidence of focal liver lesions in patients with colorectal carcinoma. J Med Assoc Thai 91:10721075, PubMed Focal sparing shows oppsite patterns on US and CT: decreased echogenicity on US images and high attenuation on CT images. All ultrasonographic examinations were performed in the ultrasound unit by experienced physicians. 57% of all liver lesions found by ultrasound are benign [5]. On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). Focal fatty sparing of the liver is the localized absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. ; Lawson, T.L. J Ultrasound Med 14:7780, Karcaaltincaba M, Akhan O (2007) Imaging of hepatic steatosis and fatty sparing. PubMed Central The Supportive Care Needs of Regional and Remote Cancer Caregivers, SOX2 and Bcl-2 as a Novel Prognostic Value in Hepatocellular Carcinoma Progression, https://doi.org/10.3390/curroncol28040265, https://www.mdpi.com/article/10.3390/curroncol28040265/s1, https://www.liver.ca/patients-caregivers/liver-diseases/fatty-liver-disease/, https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf, https://creativecommons.org/licenses/by/4.0/. Author to whom correspondence should be addressed. Parts of this manuscript were presented at the Ultrasound Dreilndertreffen 2008, Davos. Baseline and . (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. ; Israel, G.M. 2). 4: 3030-3040. 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%. Other variables included clinical data pertaining to their cancer and variables that may influence steatosis development, such as tumour location, whether primary surgical resection was performed, pelvic radiation status, steroid use, statin use, alcohol consumption, and duration and type of adjuvant chemotherapy received. 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/. 76.67% (n=1157) of diagnosed hemangiomas were solitary, and the average size of the hemangiomas was 20.1mm. We use cookies on our website to ensure you get the best experience. Scand J Gastroenterol 50:355359, Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C (2013) Fortuitously discovered liver lesions. 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. reported a prevalence of 7.2% in a population of patients with colorectal carcinoma [17]. Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. The highest prevalence was found in younger women, and 86.4% (n=70) of all patients with FNH were females. Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). ; MacFarlane, P.W. Conclusion: Detection of focal fatty sparing is associated with an increased attenuation coefficient and is thus an expression of higher-grade hepatic fatty degeneration. 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. ; Park, J.Y. Common patterns include diffuse fat accumulation, diffuse fat accumulation with focal sparing, and focal fat accumulation in an otherwise normal liver. Patients with polycystic liver diseases were excluded from this study. Joy, D.; Thava, V.R. In order to be human-readable, please install an RSS reader. The CEA level was 15.1 ng/ml and the cancer antigen 199 (CA199) level 167.4 U/ml. Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. 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. Canadian Cancer Societys Advisory Committee on Cancer Statistics. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). 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. ; Congdon, L.; Edwards, K.L. (2016) Seminars in ultrasound, CT, and MR. 37 (6): 501-510. Results that were incomplete or ambiguous were excluded from this study. Following parameters were recorded and evaluated on the basis of the above-mentioned research question: positive/negative finding, nature of tumor, age and gender of the patient, number of foci (solitary, multiple), the respective ultrasound characteristics of the focus and size of the tumor (maximum diameter). The size and age structure of the respective study populations, as well as the quality of the ultrasound equipment used, need to be considered here. 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. Focal fat deposition is slightly less common and can mimic other hepatic benign or malignant lesions on ultrasound and CT (Fig. An association between the occurrence of benign focal liver lesions and age was observed. We thank Ayesha Taqi and Aftab Malik for their generous help in the data collection process. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. 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. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. Pathological examination revealed fibrotic liver tissue adjacent to the tumor; this fibrotic tissue contained fewer fat vacuoles than the rest of the liver parenchyma. cholecystoses cholesterolosis adenomyomatosis masses gallbladder polyps gallbladder carcinoma: look for infiltration into adjacent organs, metastases, lymphadenopathy, bile duct dilatation leiomyosarcoma 1 metastases to the gallbladder: rare Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. ; Laurie, J.A. PubMed Focal sparing in diffusely fatty liver is a well recognized entity. 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. MDPI and/or and Strunk et al. Google Scholar, Sanfelippo P, Beahrs O, Weiland L (1974) Cystic disease of the liver. Become a Gold Supporter and see no third-party ads. 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]. 3) showed an irregularly shaped hypointense area in the anterior segment. Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis. 2005;14 (4): 419-25. 4) clearly showed a wedge-shaped hypointese area in the anterior segment, suggesting ischemia in this area. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Focal hepatic steatosis. These segments were rarely spared in patients with previous cholecystectomy. Wolfgang Kratzer. Severe and Late Acute Liver Injury Induced by Capecitabine. (2004) High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia. Dr. Yvette Kratzberganswered Pediatrics 26 years experience Talk now Only a very few studies investigated the prevalence of FNH, hepatic adenoma, and focal fatty sparing. Of 269 patients, 76 (28.3%) had steatosis at baseline. ; Cohen, J.C.; Grundy, S.M. Rofo 173:424429, Massironi S, Branchi F, Rossi RE, et al. Haas, J.T. Schumacher, J.D. The prevalence of hepatic hemangioma was 3.3% (n=1640), while that of FNH was 0.2% (n=81) and that of hepatic adenoma was 0.04% (n=19). (2011) Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. Gastroenterol Res Pract 2015:749235, Khosa F, Warraich H, Khan A, et al. The mean maximum measured size of the focal fatty sparing was 20.6mm. On the other hand, focal sparing in a diffusely fatty liver can be observed most frequently around the gallbladder bed, and its most common shape resembles a spot, band or ring (6). Rom J Gastroenterol. In our patient population, the prevalence of hepatic hemangioma was 3.6% (n=1640). Glucocorticoids and non-alcoholic fatty liver disease. This condition, called focal sparing, can occur in diverse patterns. 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. Hepatocellular carcinoma in the absence of cirrhosis in united states veterans is associated with nonalcoholic fatty liver disease. Ultrasound Med Biol 30:10891097, Soyer P, Bluemke DA, Van BB, Barge J, Levesque M (1993) CT of hepatic tumors: prevalence of the and specificity of retraction adjacent liver capsule. No specific therapy is available except to eliminate the cause or treat the underlying disorder. Abbreviations: BMI (Body Mass Index). Close Figure Viewer Return to Figure Previous FigureNext Figure A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). 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? Fan, R.; Wang, J.; Du, J. Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. 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]. ; Mechanick, J.I. Garvey, W.T. Li, Q.; Dhyani, M.; Grajo, J.R.; Sirlin, C.; Samir, A.E. Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. Vigano, L.; De Rosa, G.; Toso, C.; Andres, A.; Ferrero, A.; Roth, A.; Sperti, E.; Majno, P.; Rubbia-Brandt, L. Reversibility of chemotherapy-related liver injury. PubMed Central Only a few studies have determined the prevalence of FNH, hepatic adenoma and focal fatty sparing. The most common site of these pseudo lesions are hepatic segments IV and V, the gallbladder bed, the falciform ligament region, and ventral to the portal vein. It was most often found in the 5160years age group; the mean age of the patients with focal fatty sparing was 54.914.5years. 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 difference can be related to the population size and age of the patients studied [13, 14]. R.D., A.D.T., H.S., N.B. Used criteria for the diagnosis of the lesions are presented in Table1. ; Kim, T.K. Lee, J.I. Unusual patterns of hepatic steatosis caused by the local effect of insulin revealed on chemical shift MR imaging. Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. The largest measured cyst diameter averaged 22.3mm. Woods, C.P. All the cases of focal fatty sparing that we encountered were solitary findings in its typical location in liver segment IV in the region of the gallbladder bed. An elliptical mass surrounded by a halo was seen in the anterior segment of the right lobe, and its internal echogenicity was irregular (Fig. 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). The number of recent ultrasound studies on the prevalence of benign liver lesions is relatively limited. 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. Preoperative CT scan and magnetic resonance (MR) imaging in 1993 had shown a slightly fatty liver and no metastasis. Our result of 6.3% is below the prevalence figures of Kratzer et al. Medical oncologists at St. Michaels Hospital in Toronto, Canada, anecdotally observed that CRC patients receiving adjuvant chemotherapy appeared to develop fatty liver at a higher rate than expected when seen in follow-up, based on imaging. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive In many cases, the phenomenon is believed to be related to the haemodynamics of a third inflow. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. The statistical calculations were carried out using the statistics software SAS 9.2 (SAS Institute Inc., Cary, North Carolina, USA) and the data evaluated using descriptive statistics. The gallbladder holds a digestive fluid (bile) that's released into the small intestine. 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. Miwa, M.; Ura, M.; Nishida, M.; Sawada, N.; Ishikawa, T.; Mori, K.; Shimma, N.; Umeda, I.; Ishitsuka, H. Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. Following initial conception of the study, the authors retrospectively identified patients who were treated and followed up by a medical oncologist at St. Michaels Hospital, Toronto, Canada, between 1 January 2006 and 1 January 2017. 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. J Clin Ultrasound 21:115118, Gaines PA, Sampson MA (1989) The prevalence and characterization of simple hepatic cysts by ultrasound examination. Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. Advertisement intended for healthcare professionals, For reprints and all correspondence: Motohisa Kato, Second Department of Surgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500, Japan. It was suggested that the tumor caused this ischemia due to intrahepatic portal vein blockade. 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. Miyake, K.; Hayakawa, K.; Nishino, M.; Morimoto, T.; Mukaihara, S. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. Chin, S.N. There are only a few studies on the prevalence of FNH [1215]. According to existing literature, the frequency of hepatic steatosis development in CRC patients receiving 5-FU ranges from 3047% [, The use of oxaliplatin as part of the chemotherapy regimen did not appear to affect the risk of steatosis in our analysis, barring perhaps a non-significant, mildly lower rate of steatosis development in those receiving oxaliplatin compared to those on treatment regimens not containing oxaliplatin. Introduction. 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. Kaltenbach, T.EM., Engler, P., Kratzer, W. et al. Conclusions The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion. After the operation, the patient suffered from severe jaundice and hyperammonemia. Liver areas with reduced focal, rarely zonal accumulation of fat can occur in hepatic steatosis. ; Oliva, I.B. ; McKillop, J.H. 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. These findings imply that if differentiation between focal fatty sparing and a tumor is undetermined and follow-up is performed, should any change occur, then an abnormality that is no longer appreciable at follow-up is probably focal fatty sparing rather than a true tumor.

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