Contrast-enhanced computed tomography for the diagnosis of fatty liver: prospective study with same-day biopsy used as the reference standard.
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.
Kim
Dae Yoon
DY
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.
Park
Seong Ho
SH
Lee
Seung Soo
SS
Kim
Hye Jin
HJ
Kim
So Yeon
SY
Kim
Min-Young
MY
Lee
Yedaun
Y
Kim
Tae Kyoung
TK
Khalili
Korosh
K
Bae
Mi Hyun
MH
Lee
Joo Yeon
JY
Lee
Sung-Gyu
SG
Yu
Eun Sil
ES
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*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide