Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. Eur J Radiol 61:3343, Vaidyanathan S, Horrow MM (2007) Case 6: diagnosis: focal fatty sparing of the caudate lobe mimicking a mass. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. Focal sparing shows oppsite patterns on US and CT: decreased echogenicity on US images and high attenuation on CT images. Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. This is also ultimately reflected in the prevalence rates determined in the respective studies. https://www.mdpi.com/openaccess. The calculated prevalence of benign focal liver lesions shows that on the fortuitous discovery of space-occupying lesions of the liver, first consideration should be given to focal fatty sparing, simple hepatic cysts and hemangiomas. Fan, R.; Wang, J.; Du, J. methods, instructions or products referred to in the content. acquired and interpreted radiology image data. Diagnosis of focal hepatic lesions is therefore often difficult in patients with fatty infiltration. 84.2% (n=16) of patients with adenoma were women. Wolfgang Dhnert. Am J Clin Pathol 29:160162, Rungsinaporn K, Phaisakamas T (2008) Frequency of abnormalities detected by upper abdominal ultrasound. most exciting work published in the various research areas of the journal. ; Congdon, L.; Edwards, K.L. 4) clearly showed a wedge-shaped hypointese area in the anterior segment, suggesting ischemia in this area. The study was conducted in accordance with the Guidelines of the Declaration of Helsinki and the recommendations of Good Clinical Practice. In terms of the abnormal finding in the anterior segment, non-enhanced CT suggested focal sparing and sonography suggested a metastatic tumor. Association between body mass index and fatty liver risk: A dose-response analysis. Postoperative liver insufficiency and sepsis were diagnosed and intensive care including plasma exchange and administration of vancomycin was performed. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. The liver tissue containes an abnormal number of fat vacuoles (upper left), while the fibrotic liver tissue adjacent to the well differentiated adenocarcinoma contains fewer fat vacuoles than the rest of the liver parenchyma. Editors select a small number of articles recently published in the journal that they believe will be particularly For continuous variables, the mean and standard deviation were calculated, while categorical attributes were presented in absolute and relative frequencies. Liver areas with reduced focal, rarely zonal accumulation of fat can occur in hepatic steatosis. ; Park, J.Y. The examinations were evaluated for the presence of a focal area of increased attenuation in the liver in locations where focal fatty sparing typically occurs: adjacent to the gallbladder fossa and in the medial segment of the left lobe near the porta hepatis. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. permission provided that the original article is clearly cited. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. 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]. 2 test for categorical variables, unless the sample size was too small, in which case Fishers exact test was used. There are no ultrasound studies on the prevalence of hepatic adenoma within a large patient population. the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. He had undergone sigmoidectomy for well differentiated adenocarcinoma of the sigmoid colon on September 2, 1993 in our department. At least one of the lesions to be investigated was diagnosed in 15.1% (n=6839) of the patients of the total population. 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. designed the study and conducted data collection. There are only a few studies on the prevalence of FNH [1215]. The data presented in this study are available on request from the corresponding author. https://doi.org/10.3390/curroncol28040265, Subscribe to receive issue release notifications and newsletters from MDPI journals, You can make submissions to other journals. (1991) Natural history of hepatic haemangiomas: clinical and ultrasound study. 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. Kratzer et al. 3). Unable to process the form. A total of 44.9% of these patients were outpatients and 55.1% inpatients. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas (1). is fatty lever curable? ; Dzulynsky, R.; Di Tomaso, A.; Samawi, H.; Baxter, N.; Brezden-Masley, C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. Retrospective and prospective studies based on ultrasound have reported prevalence data for hepatic cysts of between 0.1% and 11.3% [7, 9, 23, 29]. Studies concerning the prevalence of benign focal liver lesions present a quite heterogeneous picture as regards the precise research question posed, the size of the population studied, and the investigative methods used. Google Scholar, Kreft B, Pauleit D, Bachmann R, et al. Google Scholar, Buscarini E, Danesino C, Plauchu H, et al. 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. The serum bilirubin and ammonia levels had recovered almost to normal by about five weeks after the operation and the patient was discharged on the 74th postoperative day. Marked increase in echogenicity with poor penetration of p. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive 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. Mostbeck GH (1996) Ultrasound screening examination of the abdomen: of value or senseless? Patient characteristics including sex, age at diagnosis, and Body Mass Index (BMI), as well as baseline comorbidities including type 2 diabetes mellitus, hyperlipidemia, and hypertension, were collected. Dr. Yvette Kratzberganswered Pediatrics 26 years experience Talk now Urinary Tract and male reproductive system It was most often found in the 5160years age group; the mean age of the patients with focal fatty sparing was 54.914.5years. Rev Esp Enferm Dig 89:771780, Strunk H, Mildenberger P, Jonas J (1992) The incidence of focal liver lesions in patients with colorectal carcinoma. Moreover, his temperature rose to 39 C on the 5th postoperative day, and methicillin-resistant Staphylococcus aureus (MRSA) was detected in his blood. The CEA level was 15.1 ng/ml and the cancer antigen 199 (CA199) level 167.4 U/ml. Color and power Doppler sonography were performed in 80 patients with a fatty liver that appeared as a fine echogenic pattern with considerable deep attenuation on sonography. The level of significance was set at =5%, and the p value was given to four decimal places. Multiple requests from the same IP address are counted as one view. If no unequivocal and/or acceptable statements about the above-mentioned parameters could be made from the re-inspected ultrasound images, these were expanded and/or measured again. 2005;14 (4): 419-25. ; Lawson, T.L. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. reported a higher prevalence of hepatic hemangioma in womenresulting that we were unable to corroborate with our data (Table3) [21, 29]. ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. 1.1 Liver 1.2 Gallbladder and bile ducts 1.3 Pancreas 1.4 Spleen 1.5 Appendix 1.6 Gastrointestinal tract 1.7 Peritoneum mesentery and omentum 1.8 Various intra-abdominal tumors 1.9 Retroperitoneum and great vessels 1.10 Adrenal glands 1.11 Abdominal wall 1.12 Miscellaneous. Focal fat deposition and focal fatty sparing. The youngest patient group, under 30years of age, was scarcely affected, with an age-specific prevalence of 0.8% (n=21). Lee, M.C.M. Srensen, P.; Edal, A.; Madsen, E.; Fenger, C.; Poulsen, M.R. (2001) Frequency of benign hepatic lesions incidentally detected with contrast-enhanced thin-section portal venous phase spiral CT. Acta Radiol 42:172520, Lam KY (2002) Autopsy findings in diabetic patients: a 27year clinicopathologic study with emphasi on opportunistic infections and cancers. Focal fatty infiltration increases the echogenicity of the liver on US images and produces low attenuation on CT images. Results that were incomplete or ambiguous were excluded from this study. J.J.K. ; Oliva, I.B. Through the division into four different genotypic subtypes, new aspects have emerged concerning prevalence and clinical presentation. 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. Only a few studies have determined the prevalence of FNH, hepatic adenoma and focal fatty sparing. The largest measured cyst diameter averaged 22.3mm. The electronic medical records of these patients were reviewed. Since fat is intracellular in liver steatosis,and not in the extracellular matrix,using infiltration to describe it is factually incorrect. PubMed Wolfgang Kratzer. Note: data are presented as frequency (percent), unless otherwise specified. It was most often found in the 51-60 years age group; the mean age of the patients with focal fatty sparing was 54.9 14.5 years. Furthermore, there is currently a lack of medical treatment for any population affected by steatosis, regardless of etiology, although a recently published population-based study suggests that statins may confer protective benefits against the development of steatosis. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). ; Syrigos, K.N. The prevalence of FNH was 0.2% (n=81). In terms of the age distribution and average size, our results correspond to those of comparable studies [13, 19]. Introduction: Focal fatty sparing is a manifestation of fatty liver. ; Katirtzoglou, N.A. Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. Radiology Review Manual. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. 1, 2, 3 This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. Radiology. The present case revealed a wedge-shaped area with an almost linear boundary and did not show a mass effect in the non-enhanced CT and MR sequence, including chemical shift images. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). An elliptical mass surrounded by a halo was seen in the anterior segment of the right lobe, and its internal echogenicity was irregular (Fig. Allison Forrest, Sam Afshari, Naiim Ali, Ahmad Alizadeh, Fariborz Mansour-Ghanaei, Soheil Hassanipour, Carmelo Corallo, Joshua Bell, Raneem Albazaz, Feiqian Wang, Kazushi Numata, Shin Maeda, Maria Stella Franz, Antonio Bottari, Carlo Saitta, Cheng Fang, Silvia Bernardo, Paul S. Sidhu, Federica Vernuccio, Roberto Cannella, Giuseppe Brancatelli, Antonio Corvino, Fabio Sandomenico, Orlando Catalano, Abdominal Radiology 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. J Clin Pathol 39:183188, Article There appears to be some relationship between the high density around the gallbladder area and the fatty liver. 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). P.A.V. 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? The presence of this finding was considered evidence of diffuse hepatic steatosis. Of 269 patients, 76 (28.3%) had steatosis at baseline. ; Gasbarrini, A.; Gasbarrini, G. Fatty liver and drugs. These segments were rarely spared in patients with previous cholecystectomy. Naturally, these cannot be recorded in retrospective ultrasound prevalence studies. It is therefore the method of choice in primary diagnostic investigations in most specialist areas of medicine, but especially for imaging the abdomen [1]. - 208.97.158.245. 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). Andr, T.; Boni, C.; Mounedji-Boudiaf, L.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Zaninelli, M.; Clingan, P.; Bridgewater, J.; et al. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). You are accessing a machine-readable page. Data of 45,319 patients (48.5% women and 51.48% men) were analyzed using a PC-based, standardized documentation system (ViewPoint GE Healthcare GmbH Wessling/Oberpfaffenhofen, Germany). (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. Normal vessel-like structures were not observed in this abnormal area. The authors declare no conflict of interest. 57% of all liver lesions found by ultrasound are benign [5]. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. 3. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. No special ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Capecitabine: An overview of the side effects and their management. J Med Assoc Thai 91:10721075, PubMed (12) reported that the basic points suggesting the presence of fatty infiltration are: 1, the abnormal area does not show an overall mass effect; 2, the vessels are normally distributed and are evident in the abnormal area. In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean SD, 35.9 1.14 months). In most cases, gallstones blocking the tube leading out of the gallbladder cause cholecystitis. methicillin-resistant Staphylococcus aureus, Oxford University Press is a department of the University of Oxford. Recently, some reports have mentioned the appearance of a focal sparing area in the generalized fatty liver. It is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. Abbreviations: BMI (Body Mass Index). 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]. Andr, T.; Boni, C.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Bonetti, A.; Clingan, P.; Bridgewater, J.; Rivera, F.; et al. Focal fat sparing and liver mass were the 2 most probable differential diagnoses suggested for the mentioned lesion. 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%. ; McKillop, J.H. Recognition of this finding is important to prevent the erroneous belief that the region of sparing is itself a mass. 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. 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. ; Guo, G.L. 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). Curr Gastroenterol Rep 17:12, Barthelmes L, Tait IS (2005) Liver cell adenoma and liver cell adenomatosis. The mean size was 39.0mm (Table3). PubMed Since drug-induced hepatotoxicity was described by Grieco et al. CAS was determined through a review of radiology reports, and images were reviewed by a single radiologist to maximize inter-rater reliability. ; Lorimer, A.R. In summary, our results show that the first possibility to be considered on the incidental discovery of space-occupying lesions of the liverespecially if hepatic steatosis is presentis focal fatty sparing. calculated a value of 9.05% in a random population collective [8]. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. Idilman IS, Ozdeniz I, Karcaaltincaba M. Hepatic Steatosis: Etiology, Patterns, and Quantification. CAS The research group of Koseoglu reported a prevalence of focal fatty sparing of up to 19.8 [18] Strunk et al. 4: 3030-3040. In our population, a maximum occurred at between 41 and 50years of age. In many cases, the phenomenon is believed to be related to the haemodynamics of a third inflow. However, while elevated levels of liver biochemical tests often correlate with a diagnosis of fatty liver, a high proportion of patients with NAFLD exhibit normal liver profiles, making these tests inappropriate diagnostic markers that may not have drastically impacted the findings presented in our study [. ; MacFarlane, P.W. 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). J Ultrasound Med 14:7780, Karcaaltincaba M, Akhan O (2007) Imaging of hepatic steatosis and fatty sparing. Here, we observed that there is a trend towards a higher rate of CAS development within one year of follow-up among stage IIIII CRC patients who received chemotherapy compared to the no treatment group. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. J Ultrasound Med 14:649652, Feldman M (1958) Hemangioma of the liver. According to histological examination of resected specimens of the colon, the tumor had invaded as far as the subserosal layer, and all of 24 extirpated lymph nodes were cancer-free. FFL may result from altered venous flow to liver, tissue hypoxia and malabsorption of lipoproteins. 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. Of the remaining 193 cases, patients receiving adjuvant chemotherapy (, Hepatic steatosis is characterized by the infiltration and accumulation of triglyceride within the liver parenchyma [, There is currently no approved pharmacologic treatment for hepatic steatosis, whether metabolic syndrome- or drug-induced. The ultrasound results in a population of (n=45,319) hospital patients over a period of 10years were examined retrospectively and evaluated for the diagnosis of benign focal liver lesions [hepatic cysts, hepatic hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing]. CT-supported studies have reported the highest figures for prevalence [15, 19]. ; Israel, G.M. (2001) Incidence and significance of small focal liver lesions in MRI. The diagnosis of FNH was confirmed primarily by CEUS. 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. ; Lee, H.S. Patients with polycystic liver diseases were excluded from this study. Fatty Liver Disease. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The mean age was 64.7years. The data are not publicly available due to patient privacy. A chest X-ray on admission showed no abnormality. Comparison of the study results is also difficult, because the studies differ with regard to the selection of the population investigated, the number of individuals investigated, and the diagnostic method used [ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) or autopsy]. On MR imaging, T1-weighted images (Fig. Please note that many of the page functionalities won't work as expected without javascript enabled. interesting to readers, or important in the respective research area.
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