Prevalence and Risk Factors of Focal Sparing in Hepatic Steatosis

Zusammenfassung

Ziel: Prävalenz, Lokalisation und mögliche Risikofaktoren einer fokalen Minderverfettung wurden bei Probanden mit einer sonografisch nachweisbaren Steatosis hepatis im Rahmen einer bevölkerungsbasierten Querschnittsstudie prospektiv untersucht. Material und Methoden: Insgesamt wurden 1624 Probanden (n = 906 Frauen; n = 718 Männer) sonografisch, laborchemisch und mittels Fragenbogen untersucht (Philips HDI 5000). Probanden mit einem Alkoholkonsum > 40 g/die bei Männern und > 20 g/die bei Frauen mit einer chronischen Hepatitis B und C, erhöhten Transaminasen (AST, ALT) und Zustand nach Nephrektomie rechts wurden aus der Auswertung ausgeschlossen. Ergebnisse: Die Prävalenz einer fokalen Minderverfettung bei Steatosis hepatis Grad I betrug 25,6 % für Männer und 13,0 % für Frauen, bei einer Steatosis hepatis Grad II/III 70,9 % für Männer und 77,6 % für Frauen. Die häufigste Lokalisation einer fokalen Minderverfettung war Segment IV der Leber. Die durchschnittliche Größe betrug 22,3 mm (Range 7 – 84 mm). Für die untersuchten Risikofaktoren „Alter” (p = 0,09) und „Zustand nach Cholezystektomie” (p = 0,09) konnte kein Zusammenhang nachgewiesen werden. Männliches Geschlecht (p = 0,02) und ein metabolisches Syndrom (Odds Ratio, 2,1; 95 %-Konfidenzinterval, 1,1 – 4,1; p = 0,02) konnten als Risikofaktoren bestätigt werden. Schlussfolgerung: Der sonografische Nachweis einer fokalen Minderverfettung bei Probanden mit einer Steatosis hepatis ist mit einem erhöhten Risiko für ein metabolisches Syndrom vergesellschaftet und stellt möglicherweise somit ein einfaches diagnostisches Kriterium zur Selektion von Risikopatienten in der täglichen Routine dar.

Abstract

Purpose: The prevalence, localization and potential risk factors for focal sparing were prospectively assessed in subjects with sonographically detectable hepatic steatosis as part of a population-based cross-sectional study. Materials and Methods: A total of 1,624 persons (n = 906 women; n = 718 men) were evaluated using ultrasonography, laboratory testing and a standardized questionnaire. The following were excluded from the analysis: subjects with reported alcohol consumption > 40 g/day (males) or > 20 g/day (females), those with known chronic hepatitis B or C infection, elevated serum transaminases (AST: m > 44 U/l, f > 33 U/l; ALT: m > 45 U/l, f > 35 U/l) and prior right nephrectomy. Results: The prevalence of focal sparing in patients with hepatic steatosis (grade I) was 25.6 % for men and 13.0 % for women. In patients with grade II/III disease, the prevalence was 70.9 % for men and 77.6 % for women. The most common site of focal sparing was in segment IV. The average diameter was 22.3 mm (range 7 – 84 mm). No correlation was found for postulated risk ”age” (p = 0.09) or ”status post cholecystectomy” (p = 0.09). Male sex (p = 0.02) and metabolic syndrome (odds ratio, 2.1; 95 % confidence interval, 1.1 – 4.1; p = 0.02) were confirmed as risk factors. Conclusion: Sonographic evidence of focal sparing in subjects with hepatic steatosis is associated with an increased risk for metabolic syndrome and may be an easily obtained diagnostic criterion in routine clinical settings.

Key words

ultrasound - screening - focal sparing - liver - hepatic steatosis

References

• 1 Prentice A M. Obesity – the inevitable penalty of civilisation.  Br Med Bull. 1997;  53 229-237
• 2 McTigue K M, Harris R, Hemphill B. et al . Screening and interventions for obesity in adults: summary of the evidence for the U. S. Preventive Services Task Force.  Ann Intern Med. 2003;  39 933-949
• 3 Zhou Y J, Li Y Y, Nie Y Q. et al . Prevalence of fatty liver disease and its risk factors in the population of South China.  World J Gastroenterol. 2007;  13 6419-6424
• 4 Zelber-Sagi S, Nitzan-Kaluski D, Halpern Z. et al . Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures.  Liver Int. 2006;  26 856-863
• 5 Bedogni G, Miglioli L, Masutti F. et al . Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study.  Hepatology. 2005;  42 44-52
• 6 Volzke H, Robinson D M, Kleine V. et al . Hepatic steatosis is associated with an increased risk of carotid atherosclerosis.  World J Gastroenterol. 2005;  11 1848-1853
• 7 Fan J G, Zhu J, Li X J. et al . Prevalence of and risk factors for fatty liver in a general population of Shanghai, China.  J Hepatol. 2005;  43 508-514
• 8 Browning J D, Szczepaniak L S, Dobbins R. et al . Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity.  Hepatology. 2004;  40 1387-1395
• 9 Bellentani S, Saccoccio G, Masutti F. et al . Prevalence of and risk factors for hepatic steatosis in Northern Italy.  Ann Intern Med. 2000;  132 112-117
• 10 Sung K C, Ryan M C, Kim B S. Relationships between estimates of adiposity, insulin resistance, and nonalcoholic fatty liver disease in a large group of nondiabetic Korean adults.  Diabetes Care. 2007;  30 2113-2118
• 11 Angelico F, Del Ben M, Conti R. et al . Non-alcoholic fatty liver syndrome: a hepatic consequence of common metabolic diseases.  J Gastroenterol Hepatol. 2003;  18 588-594
• 12 Shen Y H, Yang W S, Lee T H. Bright liver and alanine aminotransferase are associated with metabolic syndrome in adults.  Obes Res. 2005;  13 1238-1245
• 13 Saadeh S, Younossi Z M, Remer E M. et al . The utility of radiological imaging in nonalcoholic fatty liver disease.  Gastroenterology. 2002;  123 745-750
• 14 Caturelli E, Squillante M M, Andriulli A. et al . Hypoechoic Lesions in the ”Bright Liver”: A Reliable Indicator of Fatty Change. A Prospective Study.  J Gastroenterol Hepatol. 1992;  7 469-472
• 15 Szebeni A, Tolvaj G, Zalatnai A. Correlation of ultrasound attenuation and histopathological parameters of the liver in chronic diffuse liver diseases.  Eur J Gastroenterol Hepatol. 2006;  18 37-42
• 16 Palmentieri B, Sio de I, La Mura V. et al . The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis.  Dig Liver Dis. 2006;  38 485-489
• 17 Mottin C C, Moretto M, Padoin A V. et al . The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients.  Obes Surg. 2004;  14 635-637
• 18 Karcaaltincaba M, Akhan O. Imaging of hepatic steatosis and fatty sparing.  Eur J Radiol. 2007;  61 33-43
• 19 Valls C, Iannacconne R, Alba E. et al . Fat in the liver: diagnosis and characterization.  Eur Radiol. 2006;  16 2292-2308
• 20 Aubin B, Denys A, Lafortune M. Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels.  J Ultrasound Med. 1995;  14 77-80
• 21 Vaidyanathan S, Horrow M M. Case 6: Diagnosis: ”focal fatty sparing” of the caudate lobe mimicking a mass.  Ultrasound Q. 2007;  23 79-80
• 22 Kyogoku S, Shiraishi A, Ozaki Y. et al . Focal sparing of segment 2 in fatty liver: US appearance.  Radiat Med. 2004;  22 342-345
• 23 Chong V F, Fan Y F. Ultrasonographic hepatic pseudolesions: normal parenchyma mimicking mass lesions in fatty liver.  Clin Radiol. 1994;  49 326-329
• 24 Zezos P, Tatsi P, Nakos A. et al . Focal fatty liver sparing lesion presenting as a ”pseudotumour”: case report.  Acta Gastroenterol Belg. 2006;  69 323-326
• 25 Fujikawa K, Shiraki K, Ito T. et al . Focal spared area in fatty liver mimicking a tumor.  Hepatogastroenterology. 2002;  49 1253-1254
• 26 Kester N L, Elmore S G. Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients.  J Ultrasound Med. 1995;  14 649-652
• 27 Soyer P, Devine N, Somveille E. et al . Hepatic pseudolesion around the falciform ligament: prevalence on CT examination.  Abdom Imaging. 1996;  21 324-328
• 28 Paulson E K, Baker M E, Spritzer C E. et al . Focal fatty infiltration: a cause of nontumorous defects in the left hepatic lobe during CT arterial portography.  J Comput Assist Tomogr. 1993;  17 590-595
• 29 Kammen B F, Pacharn P, Thoeni R F. et al . Focal fatty infiltration of the liver: analysis of prevalence and CT findings in children and young adults.  Am J Roentgenol. 2001;  177 1035-1039
• 30 Koseoglu K, Ozsunar Y, Taskin F. et al . Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings.  Eur J Radiol. 2005;  54 388-392
• 31 Haenle M M, Brockmann S O, Kron M. et al . Overweight, physical activity, tobacco and alcohol consumption in a cross-sectional random sample of German adults.  BMC Public Health. 2006;  18 233
• 32 Imhof A, Woodward M, Doering A. et al . Overall alcohol intake, beer, wine, and systemic markers of inflammation in western Europe: results from three MONICA samples (Augsburg, Glasgow, Lille).  European Heart Journal. 2004;  25 2092-2100
• 33 World Health Organization . WHO Expert Committee on Physical Status the Use and Interpretation of Anthropometry report of a WHO expert committee (WHO technical report series). Genf: World Health Organization.  WHO Tech Rep Ser. 1995;  854 1-452
• 34 Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) . Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).  JAMA. 2001;  285 2486-2497
• 35 Saverymuttu S H, Joseph A E, Maxwell J D. Ultrasound scanning in the detection of hepatic fibrosis and steatosis.  Br Med J (Clin Res Ed). 1986;  292 13-15
• 36 Hamaguchi M, Kojima T, Itoh Y. et al . The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation.  Am J Gastroenterol. 2007;  102 2708-2715
• 37 Charatcharoenwitthaya P, Lindor K D. Role of radiologic modalities in the management of non-alcoholic steatohepatitis.  Clin Liver Dis. 2007;  11 37-54
• 38 Couinaud C. Le Foie. Etudes anatomiques et chirurgicales. Paris; Masson & Cie 1957
• 39 Matsui O, Kadoya M, Takahashi S. et al . Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage.  Am J Roentgenol. 1995;  164 1137-1140
• 40 Terayama N, Matsui O, Tatsu H. et al . Focal sparing of fatty liver in segment II associated with aberrant left gastric vein.  Br J Radiol. 2004;  77 150-152