Luciano Tarantino MD, Presenter: Nothing to Disclose

Ignazio Sordelli, Abstract Co-Author: Nothing to Disclose

Vincenzo Nocera, Abstract Co-Author: Nothing to Disclose

Antonio Schiano, Abstract Co-Author: Nothing to Disclose

Carmine Ripa, Abstract Co-Author: Nothing to Disclose

Hypoechoic areas of Focal fatty Sparing (FFS) at Ultrasound (US) in diffuse steatosis of the liver often raise diagnostic problems. Computed Tomography(CT)and/or Magnetic Resonance(MR) and/or Biopsy are the standard techniques for definitive diagnosis of FFS. We evaluated the role of Contrast Enhanced US (CEUS) in the diagnosis of FFS.

We retrospectively reviewed clinical and imaging records of 250 patients (204 males; age range:16–82 years) with 315 hypoechoic focal areas (diameter range 0.9 – 7.0 cm; mean : 2.8 cm)in liver steatosis at US. The final diagnosis was made by CT and/or MR in 178 patients with 232 nodules, by US-guided biopsy in 54 patients with 58 nodules and by clinical and US follow-up in 18 patients with 25 nodules. All patients underwent CEUS with evaluation of arterial, portal venous, and late phases after 5 ml sulfur hexafluoride i.v. injection. We compared CEUS findings with CT,MR, biopsy and follow-up results.

A final diagnosis of FFS was made in 86 out of 315 (27%)hypoechoic focal areas. CEUS pattern of FFS was “complete absence of focal liver lesions and normal distribution of liver vessels during all CEUS phases” in 83/86 cases(96%). In 3/86 cases, the CEUS findings were equivocal because of persistence of small hypoechoic images in the target areas during all phases of CEUS. In all 3 cases, biopsy proved “fatty infiltration of the liver”, and, clinical and US follow-up (12-28 months)showed absence of changes over time. All the other 229/315 focal areas showed hyperechoic or hypoechoic patterns, in contrast with surrounding parenchyma, during one or more CEUS phases. Sensitivity, specificity, positive predictive and negative predictive values of CEUS for the diagnosis of FFS were 96.5%, 100%, 100% and 98.7% respectively . No side effect related to CEUS was observed.

CEUS is a fast and safe technique, highly sensitive and specific for the diagnosis of FFS . Therefore, for this purpose, it should replace more expensive and invasive imaging techniques

Contrast Enhanced Ultrasound may replace enhanced CT and/or MR for diagnosis of Focal Fatty Sparing in liver steatosis

Tarantino, L, Sordelli, I, Nocera, V, Schiano, A, Ripa, C, Focal Fatty Infiltration in Liver Steatosis at US: Fast and Definitive Assessment with Contrast-enhanced Ultrasound.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013000.html