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


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.


CONCLUSIONS
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.
Department of Radiology, Division of Hepatobiliary Surgery and Liver Transplantation, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-Dong, Songpa-Gu, 138-040 Seoul, Korea.
Seong Ho
SH
Park
Pyo Nyun
PN
Kim
Kyoung Won
KW
Kim
Sang Won
SW
Lee
Seong Eon
SE
Yoon
Sung Won
SW
Park
Hyun Kwon
HK
Ha
Moon-Gyu
MG
Lee
Shin
S
Hwang
Sung-Gyu
SG
Lee
Eun Sil
ES
Yu
Eun Yoon
EY
Cho
D000328:Adult; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed