NAFLD and NASH by Manuel Romero-Gomez

Author:Manuel Romero-Gomez
Language: eng
Format: epub
ISBN: 9783030371739
Publisher: Springer International Publishing

Based on these signs, numerical scores can be calculated, and relate to the severity of the features of metabolic syndrome and of the histology grade of steatosis [14–16].

While the majority of patients with steatosis show a homogenous distribution of fat in the liver, 15–20% of cases show an atypical, non-uniform distribution. Zonal steatosis or focal fatty changes (FFC) refer to a bright aspect of a lobe, segment or smaller areas of the liver (most often located at the porta hepatis, adjacent to the falciform ligament and/or to the gallbladder fossa). These areas show a typical geographical shape and do not compress or infiltrate the liver vessels, which allows differentiating them from solid focal lesions. Rarely FFC can be multifocal and rounded in shape (Fig. 7.2, Panel a); in these cases, the differential diagnosis includes haemangiomas, adenomas and hyperecoic metastases and careful observation of accessory signs (lack of mass effect on adjacent tissue and vessels by FFC) is key to the final diagnosis. In difficult cases contrast-enhanced ultrasound (CEUS) can be used, since FCC show the same perfusion as the remaining parenchyma (Fig. 7.2, Panel b). Occasionally, more complex zonal or segmental steatosis can be seen (Fig. 7.3, Panel a); ultrasound elastography can provide useful data differentiating zonal steatosis from solid focal liver lesions in these cases, showing identical values of stiffness within the different parts of the parenchyma (Fig. 7.3, Panels b and d). Magnetic resonance imaging (MRI) is the method of choice to achieve a definite and final diagnosis (Fig. 7.3, Panel c).

Fig. 7.2Atypical aspects of steatosis on ultrasound. Panel (a): focal fatty changes (FFC) can be multifocal and rounded in shape such in this case (arrow). Differential diagnosis with metastasis or angiomas is difficult, and a contrast-enhanced imaging technique is often needed (CEUS, CT or MR). Panel (b): In this case, CEUS was performed; the area showed ISO-enhanced in comparison to the rest of the parenchyma in the arterial, portal and late phase, confirming the diagnosis of FFC

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