Surabhi Bajpai MBBS, DMRD, Presenter: Nothing to Disclose

Andrew P. Wright MD, Abstract Co-Author: Nothing to Disclose

Kathleen Corey MD, Abstract Co-Author: Nothing to Disclose

Debra Ann Gervais MD, Abstract Co-Author: Research Grant, Covidien AG

Dushyant V. Sahani MD, Abstract Co-Author: Nothing to Disclose

Hepatic steatosis is a frequent incidental finding  on abdominal CT. There is limited data on the impact of documentation of incidentally detected hepatic steatosis in radiology reports on PCP identification and their decision-making. The purpose of this study was to evaluate the impact of structured reporting of incidentally detected hepatic steatosis on PCP decision-making and patient management.

This retrospective study included patients who underwent abdominal CT scans for evaluation of hematuria or nephrolithiasis between January 2008 to October 2011. An independent reader evaluated the CT reports for documentation of hepatic steatosis, nature of reporting (body of report vs impression), presence of recommendations and physician contact at the time of reporting. The patient medical records were then reviewed for diagnosis of steatosis, alcohol use, medications, diagnosis of hypertension, hyperlipidemia, and diabetes. The laboratory values were also examined prior to and after CT scanning.

Out of a total of 12,000 CT scans, 356 patients had hepatic steatosis on CT reports. Out of these, 127 patients (M:F, mean age- , age range- ) were included in final analysis due to availability of follow up data. On evaluation of CT reports, hepatic steatosis was documented in the impression in 83/127 (65%) patients and in the body of report in 44/127 (35%) patients. HCV screening was performed in 6.3% of patients and 59% underwent insulin resistance screening and over 80% of patients underwent LFT and lipid screening. There was a significant difference in the rate of follow up when radiology reports commented on fatty liver in the impression vs the body (30.1% vs. 9.1%, p = 0.007). On follow up evaluation at 14 months, steatosis was commented in the PCP follow up notes in only 23% of patients. New cases of insulin resistance were identified in 36% of patients (12% diabetes, 24% pre-diabetes) who underwent screening within 14 months of imaging.

Structured radiology reporting practices for incidentally detected hepatic steatosis on CT scans significantly impacts PCP documentation rates, and our data suggest that steatosis should be recorded in impression section of reports.

Structured reporting of incidentally detected hepatic steatosis in  CT scans will enable the treating physician to take decisive action allowing significant impact on patient care and management.

Bajpai, S, Wright, A, Corey, K, Gervais, D, Sahani, D, Structured Reporting of Incidentally Detected Hepatic Steatosis in Abdominal CTs: Impact on Physician Practices and Patient Management.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024765.html