Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Macroscopic observation of the sliced resected specimen showed that the tumor was elliptic and not encapsulated, measuring 6.0 x 5.5 x 5.0 cm. Abdom Radiol 41, 2532 (2016). The CEA level was 15.1 ng/ml and the cancer antigen 199 (CA199) level 167.4 U/ml. Kreft, B.P. Is hepatic steatosis reversible? ; Szczepaniak, L.S. J Ultrasound Med 14:649652, Feldman M (1958) Hemangioma of the liver. ; Guo, G.L. Gut Liver. Lee, J.I. Effects of Statin Use on the Development and Progression of Nonalcoholic Fatty Liver Disease: A Nationwide Nested Case-Control Study. The treatment for ALD focuses on treating alcohol use disorder. 5. The age-dependent frequency of hepatic steatosis and the related prevalence of focal fatty sparing in patients with hepatic steatosis were also determined (Table2). Urinary Tract and male reproductive system PubMed Woods, C.P. J Am Soc Echocardiogr 25:553557, Kratzer W, Akinli AS, Bommer M, et al. (2015) Hepatic hemangioma in celiac patients: data from a large consecutive series. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). This proved that the lesion was an adenocarcinoma and right hepatectomy was performed on July 4, 1996. Histological examination revealed that the tumor, a well differentiated adenocarcinoma, was surrounded by fibrotic tissue, and that this fibrotic tissue contained fewer fat vacuoles than the rest of the liver parenchyma (Fig. In our study, this figure fell almost linearly with increasing age and amounted to only 66.8% in the group of patients over 70years of age. volume41,pages 2532 (2016)Cite this article. At the time the article was last revised Jeremy Jones had no recorded disclosures. Such atypical cases may simulate neoplasms on CT scans (1,810). The level of significance was set at =5%, and the p value was given to four decimal places. Diagnosis of fatty liver with MR imaging. Focal fat deposition and focal fatty sparing. The serum total bilirubin level rose to 19.9 mg/dl on the 11th postoperative day. As with hemangioma, there are a comparatively large number of prevalence studies for hepatic cysts, but they also differ in terms of study size, patient populations investigated, and diagnostic techniques used. ; Arevalos, E.; Rimm, A.A. Focal hepatic masses and fatty infiltration detected by enhanced dynamic CT. Rofsky, N.M.; Fleishaker, H. CT and MRI of diffuse liver disease. This condition, called focal sparing, can occur in diverse patterns. Browning, J.D. However, few reports described nodular . Miwa, M.; Ura, M.; Nishida, M.; Sawada, N.; Ishikawa, T.; Mori, K.; Shimma, N.; Umeda, I.; Ishitsuka, H. Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. and C.B.-M. contributed to the conception and design of the study. 2 test for categorical variables, unless the sample size was too small, in which case Fishers exact test was used. An elliptical mass surrounded by a halo was seen in the anterior segment of the right lobe, and its internal echogenicity was irregular (Fig. Lupsor M, Badea R. Imaging diagnosis and quantification of hepatic steatosis: is it an accepted alternative to needle biopsy? Due to the continuously improving technical standard of ultrasound equipment and the high number of abdominal ultrasound examinations, the number ofoften fortuitouslydiscovered focal liver lesions, the so-called incidentalomas, is also increasing markedly [2]. PubMedGoogle Scholar. Diagnosis of focal hepatic lesions is therefore often difficult in patients with fatty infiltration. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. 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). (2016) Seminars in ultrasound, CT, and MR. 37 (6): 501-510. From six or more foci upwards, these were combined as more than five lesions. The information about lesion size was based on the maximum measurable diameter in each case. Opposed-phase images showed a hyperintense area in the entirely hypointense liver (Fig. Ultrasound Q 23:7980, Kester NL, Elmore SG (1995) Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. Correspondence to 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]. (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. Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. Women were somewhat more affected (56.1%, n=1477) than men (43.9%, n=1154). The relative risk of developing steatosis was not significantly different regardless of statin therapy status at the time of adjuvant chemotherapy (RR 0.45, 95% CI 0.10 to 2.75) after adjusting for sex, BMI, type 2 diabetes mellitus, and hyperlipidemia (, In the present study, the adjusted relative risk of adjuvant chemotherapy reflected a moderately increased risk of steatosis, although the confidence intervals were wide. The sample size of 37 in the statin group meant that the power of the statistical analysis was smaller than the widely accepted threshold of 80%. Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. However, it occasionally creates some problems in the diagnosis of hepatic mass lesions. Conversely, some cases of true hepatic masses have been reported to mimic fatty infiltration (11) or focal sparing (12). https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. Unable to process the form. Hepatic toxicity associated with fluorouracil plus levamisole adjuvant therapy. 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. Garvey, W.T. The finding of a FNH or an adenoma is rarely a fortuitous result. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. St. Michaels Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada, Medical Sciences Building, 1 Kings College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada, Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada, Lunenfeld-Tanenbaum Research Institute, 600 University Ave, Toronto, ON M5G 1X5, Canada. CTAP showed a wedge-shaped ischemic area. The serum albumin level was 3.2 g/dl (normally 3.94.9 g/dl) and the cholinesterase level 108 IU/l (185430 IU/l). 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). Editors select a small number of articles recently published in the journal that they believe will be particularly (d) In-phase MR images show a hypointense area in the entirely hyperintense liver (TR = 120, TE = 4.2). Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. ; Laurie, J.A. Despite its frequent association with liver injury, oxaliplatin is classically known to damage the liver via sinusoidal dilation and is thought to have a limited role in inducing steatohepatitis [, Since the FDA approval of capecitabine in 2001 as a chemotherapeutic agent, the oral route of 5-FU delivery became a mainstay of colorectal cancer treatment, alongside intravenous infusion. (2010) Prevalence and risk factors of focal sparing in hepatic steatosis. Note: data are presented as frequency (percent), unless otherwise specified. 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. Google Scholar, Buscarini E, Danesino C, Plauchu H, et al. Fatty Liver Disease. It may include one or more of the following: supervised medical detox behavioral therapies, such as cognitive behavioral therapy or. ; Sada, Y.H. These segments were rarely spared in patients with previous cholecystectomy. Following initial conception of the study, the authors retrospectively identified patients who were treated and followed up by a medical oncologist at St. Michaels Hospital, Toronto, Canada, between 1 January 2006 and 1 January 2017. Eur J Clin Microbiol Infect Dis 29:307309, Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G (2014) Lets go out of the breast: prevalence of extra-mammary findings and their characterization on breast MRI. The liver was examined in inter- and/or subcostal planes with a fan-like motion allowing assessment of both the hepatic parenchyma and the intrahepatic bile ducts. Hepatocellular carcinoma in the absence of cirrhosis in united states veterans is associated with nonalcoholic fatty liver disease. ; Kim, T.K. An evidence-based review of statin use in patients with nonalcoholic fatty liver disease. 3). Eur J Radiol 61:3343, Vaidyanathan S, Horrow MM (2007) Case 6: diagnosis: focal fatty sparing of the caudate lobe mimicking a mass. The Supportive Care Needs of Regional and Remote Cancer Caregivers, SOX2 and Bcl-2 as a Novel Prognostic Value in Hepatocellular Carcinoma Progression, https://doi.org/10.3390/curroncol28040265, https://www.mdpi.com/article/10.3390/curroncol28040265/s1, https://www.liver.ca/patients-caregivers/liver-diseases/fatty-liver-disease/, https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf, https://creativecommons.org/licenses/by/4.0/. Sigler, M.A. 3. Areas of focal fatty sparing of the liver adjacent to the gallbladder and porta hepatis, absolute value of liver density less than 40 HU or a density difference greater than 25 HU between the spleen and liver on contrast-enhanced CT, increased echogenicity of the liver, attenuation of the ultrasound wave, loss of definition of the diaphragm, and poor delineation of the intrahepatic architecture on ultrasound and signal drop of liver parenchyma on the T1 weighted out of phase imaging on MRI was considered fatty liver [, A log binomial regression model was used to calculate adjusted relative risks. It was most often found in the 5160years age group; the mean age of the patients with focal fatty sparing was 54.914.5years. 2014;8(2):219-23. congenital malformations and anatomical variants. On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. (1991) Natural history of hepatic haemangiomas: clinical and ultrasound study. Grieco, A.; Forgione, A.; Miele, L.; Greco, A.V. Katsiki, N.; Mikhailidis, D.; Mantzoros, C. Non-alcoholic fatty liver disease and dyslipidemia: An update. Through higher performance ultrasound equipment and the introduction of contrast-enhanced ultrasound, the diagnosis of FNH can nowadays be made with higher sensitivity and specificity [31]. The data presented in this study are available on request from the corresponding author. those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). ; Compton, C.C. The used probes are C2-5, C1-5, and C1-6 (16MHz). 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]. Several studies on the prevalence of focal liver lesions are primarily concerned with just one individual type of lesion or they investigate the prevalence for a given pre-existing disease [11, 1921]. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin and adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. ; Park, J.Y. Miyake, K.; Hayakawa, K.; Nishino, M.; Morimoto, T.; Mukaihara, S. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. https://doi.org/10.3390/curroncol28040265, Subscribe to receive issue release notifications and newsletters from MDPI journals, You can make submissions to other journals. Hepatic pseudolesion: appearance of focal low attenuation in the medial segment of the left lobe at CT arterial portography. With only 19 cases and hence a prevalence of 0.04%, hepatic adenoma was the rarest of the liver lesions we investigated. ; Tomlinson, J.W. (b) CT during arterial portography clearly shows a wedge-shaped hypointese area in the anterior segment, indicating ischemia, due to intrahepatic portal vein blockade. Between 01/2003 and 11/2013, the liver was examined by ultrasound in a total of 45,319 patients, of whom 48.5% were women (n=21,988) and 51.48% men (n=23331). Sohn J, Siegelman E, Osiason A. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). Pathological examination revealed fibrotic liver tissue adjacent to the tumor; this fibrotic tissue contained fewer fat vacuoles than the rest of the liver parenchyma. https://www.mdpi.com/openaccess. ; Brett, E.M.; Garber, A.J. You are accessing a machine-readable page. 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. The prevalence data published so far on hepatic adenoma are between 0.4% and 1.7%. Without continually carrying out new studies at regular intervals, no comparative statements concerning possible changes in the prevalence of benign focal liver lesions over time are possible. ; Perlman, S.J. Alkhouri, N. NASH and NAFLD: Emerging drugs, therapeutic targets and translational and clinical challenges. J Med Assoc Thai 91:10721075, PubMed ; McKillop, J.H. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. Focal hepatic steatosis. Wolfgang Kratzer. Slider with three articles shown per slide. ; Lorimer, A.R. Out of the 269 patients deemed eligible for analysis, 76 (28.3%) had fatty liver at baseline imaging, prior to treatment with adjuvant chemotherapy. We present the radiological features of this case and discuss how to arrive at a correct diagnosis. is there a problem of fatty lever? View Frank Gaillard's current disclosures, View Raymond Chieng's current disclosures, see full revision history and disclosures, World Health Organisation 2001 classification of hepatic hydatid cysts, recurrent pyogenic (Oriental) cholangitis, combined hepatocellular and cholangiocarcinoma, inflammatory myofibroblastic tumour (inflammatory pseudotumour), 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 haemorrhagic telangiectasia (Osler-Weber-Rendu disease), cystic pancreatic mass differential diagnosis, pancreatic perivascular epithelioid cell tumour (PEComa), pancreatic mature cystic teratoma (dermoid), revised Atlanta classification of acute pancreatitis, acute peripancreatic fluid collection (APFC), hypertriglyceridaemia-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). In most cases, gallstones blocking the tube leading out of the gallbladder cause cholecystitis. 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. Srensen, P.; Edal, A.; Madsen, E.; Fenger, C.; Poulsen, M.R. Kratzer et al. Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. In order to be human-readable, please install an RSS reader. Please note that many of the page functionalities won't work as expected without javascript enabled. No special Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. ; Neuschwander-Tetri, B.A. The purpose of this study was to investigate whether fatty sparing adjacent to the gallbladder fossa is related to efferent blood flow from the gallbladder wall. On average, women were aged 56.118.8years and men 55.917.4years. Alpern, M.B. 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. Multiple FNHs were rare; the prevalence of solitary FNHs was 88.9% (n=72), and the average size was 51.6mm. ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. In order to demonstrate differences between patients with and without a lesion, the Wilcoxon signed rank-sum test was applied for continuous variables and the The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. Nodular focal fatty sparing of liver sometimes is a mimicker of malignant lesion, especially metastatic tumor. 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). Multiple requests from the same IP address are counted as one view. ; Foley, W.D. Search for other works by this author on: Department of Pathology, Gifu University School of Medicine, Focal spared areas in fatty liver caused by regional decreased portal flow, Nodular focal fatty infiltration of the liver: CT appearance, Multifocal fatty infiltration of the liver: report of six cases, A case of focal fatty liver difficult to distinguish from the liver metastasis of rectal cancer on CT, Focal sparing around the gallbladder in fatty liver: a useful sign for the diagnosis of borderline cases by CT, Focal manifestations of diffuse liver disease at MR imaging, Focal spared area in fatty liver simulaing a mass: Scintigraphic evaluation, Focal sparing in fatty infiltration of the liver, Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver, Liver metastases from ovarian cystadenocarcinoma masquarading on CT as lobar fatty infiltration, Metastatic tumors in irregular fatty liver mimicking focal sparing, Projection of the number of new cancer cases in the world, Cross-cultural comparison of continuous deep sedation for advanced cancer patients in East Asian countries: prospective cohort study, The efficacy and safety of trastuzumab deruxtecan (T-DXd) in HER2-expressing solid tumours: a single-arm meta-analysis, A new era of the Asian clinical research network: a report from the ATLAS international symposium, Factors affecting polyglycolic acid sheet engraftment success for covering mucosal defects from head and neck surgery, About Japanese Journal of Clinical Oncology, Receive exclusive offers and updates from Oxford Academic. 57% of all liver lesions found by ultrasound are benign [5]. AJR Am J Roentgenol. 2023 Springer Nature Switzerland AG. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. 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. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. Become a Gold Supporter and see no third-party ads. In line with our results, all studies reported a higher prevalence of hepatic cysts with increasing age [19, 22, 23, 30].