title: Contrast-enhanced computed tomography for the diagnosis of fatty liver: prospective study with same-day biopsy used as the reference standard.
abstract: OBJECTIVE
  The study purpose was to prospectively determine the accuracy of contrast-enhanced CT in diagnosing fatty liver using same-day biopsy as the reference standard.
  
  
  METHODS
  One hundred seventy-nine potential living liver donors underwent unenhanced and portal-phase contrast-enhanced hepatic CT and subsequent liver biopsy on the same day. Attenuation difference between the liver and the spleen on unenhanced (( pre ) L-S) and contrast-enhanced (( post ) L-S) images and blood-subtracted hepatic attenuation on contrast-enhanced images (( post ) L-B), calculated by [L - 0.3 x (0.75 x P + 0.25 x A)]/0.7 where L, P and A represent the attenuation of the liver, main portal vein and abdominal aorta, respectively, were obtained. The accuracy of these indices in diagnosing fatty liver according to various threshold levels, 5%-30% histological steatosis in increments of 5%, was compared using ROC analysis.
  
  
  RESULTS
  The area under the ROC curve for ( pre ) L-S, ( post ) L-S and ( post ) L-B was 0.663-0.918, 0.712-0.847 and 0.821-0.923, respectively, depending on the threshold levels of hepatic steatosis. The accuracy of ( pre ) L-S and ( post ) L-S did not differ (P >or= 0.054), despite a trend towards a lower accuracy with ( post ) L-S. ( post ) L-B yielded higher accuracy than ( pre ) L-S at threshold levels of 5% and 10% (P <or= 0.002) and similar accuracy to ( pre ) L-S at the other threshold levels (P >or= 0.144).
  
  
  CONCLUSIONS
  Portal-phase contrast-enhanced CT has a similar, or even greater, accuracy than unenhanced CT in diagnosing fatty liver.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2dong, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Dae Yoon
authors.initials: DY
authors.lastname: Kim
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Min-Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Yedaun
authors.initials: Y
authors.lastname: Lee
authors.forename: Tae Kyoung
authors.initials: TK
authors.lastname: Kim
authors.forename: Korosh
authors.initials: K
authors.lastname: Khalili
authors.forename: Mi Hyun
authors.initials: MH
authors.lastname: Bae
authors.forename: Joo Yeon
authors.initials: JY
authors.lastname: Lee
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Eun Sil
authors.initials: ES
authors.lastname: Yu
mesh_terms: D000328:Adult; D001706:Biopsy; D003287:Contrast Media; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods*; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide