Differentiation between true focal liver lesions and pseudolesions in patients with fatty liver: evaluation of helical CT criteria.
OBJECTIVE
To determine the potential of helical CT for differentiating true lesions from pseudolesions in patients with fatty liver.


METHODS
Helical CT of 44 patients with diffuse fatty liver (22 with true lesions; 22 with pseudolesions) were reviewed by two observers with regard to morphological features of visible lesions. Univariate analysis was used to detect discriminating criteria for the diagnosis of true lesions.


RESULTS
Interobserver agreement was excellent for 9/10 morphological criteria (kappa = 0.831-1). True lesions were more frequently distant from the liver capsule (50.00% vs. 4.55%), located in the right lobe (72.73% vs. 31.82%), round (86.36% vs. 54.55%), heterogeneous (27.27% vs. 0.00%) and had ill-defined margins (40.91% vs. 13.64%) compared with pseudolesions (P < 0.05). Using univariate analysis, a location distant from the liver capsule was the most discriminating variable to differentiate between true and pseudolesions (P = 0.0060). Hyperattenuating content and round shape were the most sensitive criteria (sensitivity = 90.91% and 86.36%, respectively) for the diagnosis of true lesions, and heterogeneity, vascular displacement and encapsulation were the three most specific ones (specificity = 100.00%). Best accuracy was obtained with an association of the three variables (accuracy = 86.36%).


CONCLUSIONS
Helical CT provides objective and discriminating morphological criteria to differentiate between true lesions and pseudolesions in patients with fatty liver.
Soyer
Philippe
P
Departments of Abdominal Imaging, Lariboisière Hospital-AP-HP-GHU Nord and University Paris 7, Paris, France. philippe.soyer@lrb.aphp.fr
Sirol
Marc
M
Fargeaudou
Yann
Y
Duchat
Florent
F
Hamzi
Lounis
L
Boudiaf
Mourad
M
Aout
Mounir
M
Guerrache
Youcef
Y
Vicaut
Eric
E
Rymer
Roland
R
D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D036542:Tomography, Spiral Computed