Recently, some reports have mentioned the appearance of a focal sparing area in the generalized fatty liver. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). Disclaimer/Publishers Note: The statements, opinions and data contained in all publications are solely Studies concerning the prevalence of benign focal liver lesions present a quite heterogeneous picture as regards the precise research question posed, the size of the population studied, and the investigative methods used. Naturally, these cannot be recorded in retrospective ultrasound prevalence studies. Obika, M.; Noguchi, H. Diagnosis and evaluation of nonalcoholic fatty liver disease. In our patient population, the prevalence of hepatic hemangioma was 3.6% (n=1640). Rofo 156:325327, Koseoglu K, Ozsunar Y, Taskin F, Karaman C (2005) Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings. MRI exhibits the highest sensitivity for detecting hepatic lipid infiltration and can detect as little as 5% steatosis in the liver at a sensitivity of 76.790.0% and a specificity of 87.191% [, Another limitation of this study is the relatively small sample size, particularly for the cohort of patients receiving statins. Endocr Pathol 13:3945, Gandolfi L, Leo P, Solmi L, et al. 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]. The prevalence of FNH lies between 0.8% and 3.2% [1215], of hepatic adenoma from 0.4% to 1.5% [11, 12, 15, 16], and of focal fatty sparing between 7.2% and 19.8% [8, 17, 18]. No special There was also a hypoechoic mass in segment 6 of the liver measuring, 4.8 3.1 cm. Although these four sequences suggested focal sparing, dynamic MR images clearly showed irregular enhancement in the abnormal area of the anterior segment, suggesting a metastatic tumor (image not shown). Gut Liver. Current Oncology. CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. Wolfgang Kratzer. Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. It is important for the subsequent diagnosis and therapy and the associated expended time and effort of the treating physician and the affected patientto say nothing of the related coststhat the focus visible on ultrasound is classified as reliably as possible [4]. 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). Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. Ann Surg 179:922925, Seitz K, Strobel D, Bernatik T, et al. 57% of all liver lesions found by ultrasound are benign [5]. 2023 Springer Nature Switzerland AG. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for 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., Lee, Michelle C. M., Jacob J. Kachura, Paraskevi A. Vlachou, Raissa Dzulynsky, Amy Di Tomaso, Haider Samawi, Nancy Baxter, and Christine Brezden-Masley. You are accessing a machine-readable page. As regards the age distribution, the respective age-specific prevalence began with 7.0% (n=115) in the youngest patients and rose to a maximum of 22.5% (n=369) of all discovered hemangiomas in the age group between 51 and 60years. is fatty lever curable? The used probes are C2-5, C1-5, and C1-6 (16MHz). Grieco, A.; Forgione, A.; Miele, L.; Greco, A.V. Gandolfi et al. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. This distribution is the same as that seen in focal fatty sparing and is thought to relate to variations in vascular supply. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Onaya et al. 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). This condition, called focal sparing, can occur in diverse patterns. Only a few studies have determined the prevalence of FNH, hepatic adenoma and focal fatty sparing. Abdom Radiol 41, 2532 (2016). ; Hazlehurst, J.M. ; Petersen, O.F. In the case of hepatic cysts, the range of prevalence figures from CT, MRI, or autopsy studies is also much wider than that of the ultrasound-based studies [5, 10, 15, 19, 30]. (2010) Prevalence and risk factors of focal sparing in hepatic steatosis. Apart from 2 exceptions, all diagnosed adenomas were solitary findings (89.5%, n=17). Joy, D.; Thava, V.R. Eur J Radiol 83:930934, Marin D, Galluzzo A, Plessier A, et al. Mechanisms of NAFLD development and therapeutic strategies. The prevalence of hepatic hemangioma was 3.3% (n=1640), while that of FNH was 0.2% (n=81) and that of hepatic adenoma was 0.04% (n=19). Pastori, D.; Polimeni, L.; Baratta, F.; Pani, A.; Del Ben, M.; Angelico, F. The efficacy and safety of statins for the treatment of non-alcoholic fatty liver disease. The diagnosis of FNH was confirmed primarily by CEUS. 4 and 5). In this study, Stage IIIII colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. Association between body mass index and fatty liver risk: A dose-response analysis. ; Hobbs, H.H. In general, the treatment of the underlying condition will reverse the findings. Color and power Doppler sonography were performed in 80 patients with a fatty liver that appeared as a fine echogenic pattern with considerable deep attenuation on sonography. in 2005, there has been some research on the association between steatosis and anti-tumour drugs, although the precise impacts of CRC chemotherapy have largely been unexplored. Effects of Statin Use on the Development and Progression of Nonalcoholic Fatty Liver Disease: A Nationwide Nested Case-Control Study. In terms of the abnormal finding in the anterior segment, non-enhanced CT suggested focal sparing and sonography suggested a metastatic tumor. An association between the occurrence of benign focal liver lesions and age was observed. ; Dzulynsky, R.; Di Tomaso, A.; Samawi, H.; Baxter, N.; Brezden-Masley, C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. At the time the article was last revised Jeremy Jones had no recorded disclosures. 5). ; Gasbarrini, A.; Gasbarrini, G. Fatty liver and drugs. 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]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. Mechanistic review of drug-induced steatohepatitis. Fatty Liver Grade three || Diffuse Fatty infiltration || Focal fatty sparingLiver: Normal in size. Used criteria for the diagnosis of the lesions are presented in Table1. Gastroenterol Res Pract 2015:749235, Khosa F, Warraich H, Khan A, et al. The present case revealed a wedge-shaped area with an almost linear boundary and did not show a mass effect in the non-enhanced CT and MR sequence, including chemical shift images. PubMed Central Unusual patterns of hepatic steatosis caused by the local effect of insulin revealed on chemical shift MR imaging. Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. (2009) Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesionsprospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). 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. Medical oncologists at St. Michaels Hospital in Toronto, Canada, anecdotally observed that CRC patients receiving adjuvant chemotherapy appeared to develop fatty liver at a higher rate than expected when seen in follow-up, based on imaging. 2. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. The presence of this finding was considered evidence of diffuse hepatic steatosis. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Data of 45,319 patients (48.5% women and 51.48% men) were analyzed using a PC-based, standardized documentation system (ViewPoint GE Healthcare GmbH Wessling/Oberpfaffenhofen, Germany). ; Charlton, M. Changes in the Prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. All articles published by MDPI are made immediately available worldwide under an open access license. Results with inadequate or incomprehensible written or visual documentation of the finding were excluded from the study. ; Packard, C.J. designed the study and conducted data collection. We often found a high attenuation region around the gallbladder bed in the fatty liver patients on CT examination. ; Kramer, J.R.; Richardson, P.A. ; Tomlinson, J.W. 84.2% (n=16) of patients with adenoma were women. Focal fat deposition and focal fatty sparing. Focal Fatty Infiltration of the Liver. In many cases, the phenomenon is believed to be related to the haemodynamics of a third inflow. Woods, C.P. In contrast, in-phase images showed a hypointense area in the entirely hyperintense liver (Fig. A full blood count on admission showed normal values. These findings imply that if differentiation between focal fatty sparing and a tumor is undetermined and follow-up is performed, should any change occur, then an abnormality that is no longer appreciable at follow-up is probably focal fatty sparing rather than a true tumor. Such atypical cases may simulate neoplasms on CT scans (1,810). Improved overall survival with oxaliplatin, fluorouracil, and leucovorin and adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. Radiology. future research directions and describes possible research applications. ; Syrigos, K.N. Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. The frequency of focal fatty sparing in patients with hepatic steatosis decreased with age and in the youngest age group of patients with hepatic steatosis, namely under 30years of age, the specific prevalence of focal fatty sparing was over 90%. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. All authors have read and agreed to the published version of the manuscript. HPB (Oxford) 7:186196, Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany, Tanja Eva-Maria Kaltenbach,Phillip Engler,Wolfgang Kratzer,Suemeyra Oeztuerk,Thomas Seufferlein&Mark Martin Haenle, Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany, Zentraler Ultraschall, Klinik fr Innere Medizin I, Zentrum fr Innere Medizin, Universittsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany, You can also search for this author in 3. Editors Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Differential diagnosis Moreover, there is evidence to believe that larger, higher power studies should be conducted to further investigate the protective benefits of statins in reducing the risk of CAS, owing to the mild reduction in the adjusted relative risk of steatosis in statin users observed in the present study. On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). ; 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. He had undergone sigmoidectomy for well differentiated adenocarcinoma of the sigmoid colon on September 2, 1993 in our department. Comparison of the study results is also difficult, because the studies differ with regard to the selection of the population investigated, the number of individuals investigated, and the diagnostic method used [ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) or autopsy]. In comparison with CT, MRI, and autopsy studies, which show a far higher range of prevalence, our figure is in the lower third [10, 11, 19, 20]. These conclusions have critical implications on the quality of life and hepatic function of patients not only in the curative setting, but may also be applicable in the setting of treatment of metastatic disease, in particular in context of patients requiring liver resections for metastases in addition to indefinite metastatic treatment which may require up to 60 cycles of 5-FU-based chemotherapy. (2012) Prevalence of non-cardiac pathology on clinical transthoracic echocardiography. (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. Become a Gold Supporter and see no third-party ads. Eur J Radiol 61:3343, Vaidyanathan S, Horrow MM (2007) Case 6: diagnosis: focal fatty sparing of the caudate lobe mimicking a mass. Hepatic steatosis secondary to capecitabine: A case report. 1. In terms of the age distribution and average size, our results correspond to those of comparable studies [13, 19]. Idilman IS, Ozdeniz I, Karcaaltincaba M. Hepatic Steatosis: Etiology, Patterns, and Quantification. Hepatology 50:481489, Thapar M, Grapp O, Fisher C (2015) Management of hepatic adenomatosis. Results that were incomplete or ambiguous were excluded from this study. J Ultrasound Med 14:7780, Karcaaltincaba M, Akhan O (2007) Imaging of hepatic steatosis and fatty sparing. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Close Figure Viewer Return to Figure Previous FigureNext Figure Prevention of coronary heart diseases with pravastatin in men with hypercholesterolemia: West of Scotland coronary prevention study group. 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. 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). In line with our results, all studies reported a higher prevalence of hepatic cysts with increasing age [19, 22, 23, 30]. FFL may result from altered venous flow to liver, tissue hypoxia and malabsorption of lipoproteins. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. ; Compton, C.C. The electronic medical records of these patients were reviewed. AJR Am J Roentgenol. ; Oliva, I.B. 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. Besides the clinical parameters and the patients medical history, the quality of the ultrasound equipment used and the investigators experience also play a significant role. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. Kreft, B.P. 1.1 Liver 1.2 Gallbladder and bile ducts 1.3 Pancreas 1.4 Spleen 1.5 Appendix 1.6 Gastrointestinal tract 1.7 Peritoneum mesentery and omentum 1.8 Various intra-abdominal tumors 1.9 Retroperitoneum and great vessels 1.10 Adrenal glands 1.11 Abdominal wall 1.12 Miscellaneous. and Strunk et al. You may want to read more about NASH here: (2004) High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia. [8, 17]. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. It may include one or more of the following: supervised medical detox behavioral therapies, such as cognitive behavioral therapy or. articles published under an open access Creative Common CC BY license, any part of the article may be reused without It was suggested that this fibrotic liver tissue corresponded to the area of focal sparing seen on CT and MR images. Friedman, S.L. most exciting work published in the various research areas of the journal. On admission, his general condition was good. (2011) Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. CT-supported studies have reported the highest figures for prevalence [15, 19]. 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. The mean age was 64.7years. PubMed Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. positive feedback from the reviewers. If no unequivocal and/or acceptable statements about the above-mentioned parameters could be made from the re-inspected ultrasound images, these were expanded and/or measured again. The prevalence of 0.04% determined by us is considerably lower than that found in the previous studies. reported a prevalence of 7.2% in a population of patients with colorectal carcinoma [17]. While liver enzymes play a central role in the three-step enzymatic cascade of capecitabine activation to its active metabolite, hepatotoxicity is considered a relatively rare side effect of capecitabine due to its selective activation within the tumor tissue [, Considering the low survival rates of CRC patients in the absence of treatment, adverse effects of CRC chemotherapy have been regarded as inevitable consequences of a necessary life-saving measure. Serum electrolytes, blood urea nitrogen, creatinine, glucose, total bilirubin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), leucine aminopeptidase (LAP) and gamma-glutamyltranspeptidase (g-GTP) were all within the normal ranges. Focal fatty sparing of the liver is the localized absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 4: 3030-3040. The finding of a FNH or an adenoma is rarely a fortuitous result. By definition, fatty sparing occurs in patients with diffuse fatty infiltration of the liver, which may be idiopathic or secondary to obesity, starvation, parenteral nutrition, steroid therapy, diabetes mellitus, alcohol, and hepatitis. ; Israel, G.M. Motohisa Kato, Shigetoyo Saji, Masayuki Kanematsu, Daizo Fukada, Kiichi Miya, Takao Umemoto, Katsuyuki Kunieda, Yasuyuki Sugiyama, Ikuhide Kuwahara, Kuniyasu Shimokawa, A Case of Liver Metastasis from Colon Cancer Masquerading as Focal Sparing in a Fatty Liver, Japanese Journal of Clinical Oncology, Volume 27, Issue 3, June 1997, Pages 189192, Slider with three articles shown per slide. The Supportive Care Needs of Regional and Remote Cancer Caregivers, SOX2 and Bcl-2 as a Novel Prognostic Value in Hepatocellular Carcinoma Progression,,,,, Fatty Liver Disease. To date, only a few studies have been published on the prevalence of focal fatty sparing or of focal fat distribution disorders in the liver [8, 27]. CT arteriogrphy (CTA) (Fig. Examinations were performed using following devices: Philips HDI 3000, HDI 5000, IU22, Toshiba Aplio 500, and Siemens Acuson S3000. Diagnosis of fatty liver disease: Is biopsy necessary? 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. and C.B.-M. contributed to the conception and design of the study. 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]., DOI: No specific therapy is available except to eliminate the cause or treat the underlying disorder. In order to be human-readable, please install an RSS reader. 1. 76.67% (n=1157) of diagnosed hemangiomas were solitary, and the average size of the hemangiomas was 20.1mm. ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. The level of significance was set at =5%, and the p value was given to four decimal places. ; Park, J.Y. For example, the prevalence of hepatic hemangioma determined in the studies ranged from 0.1% to 20.0% and that of hepatic cysts from 0.06% to 17.8%. 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 Focal gallbladder wall thickening (differential). Of the remaining 193 cases, patients receiving adjuvant chemotherapy (, Hepatic steatosis is characterized by the infiltration and accumulation of triglyceride within the liver parenchyma [, There is currently no approved pharmacologic treatment for hepatic steatosis, whether metabolic syndrome- or drug-induced. The number of recent ultrasound studies on the prevalence of benign liver lesions is relatively limited. "Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer" Current Oncology 28, no.
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