Unequal distribution of liver fat warrants careful selection of biopsy site during donor assessment

Abstract

INTRODUCTION & OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a major health concern. Liver fat deposition seems to have a segmental variation. This can affect invasive, and non-invasive detection of NAFLD. The present study evaluates the pattern of fat distribution of the liver using liver computed tomogram (CT) attenuation index. METHODS: Two radiologists evaluated 517 non-contrast CT abdomen and pelvis images. Two 40mm2 regions of interest (ROIs) were selected from each segment. The hepatic segmental densities were obtained by calculating the mean densities of areas of corresponding liver segments. The mean hepatic attenuation (MHA) was quantified by obtaining the mean segmental densities. Densities were compared among segments and with the MHA. RESULTS: The median age was 58 years (min-max: 9-88; IQR: 45-67) and 276 (53.4 %) were males. The overall median hepatic density (i.e. grand median) was 53.05 (95% CI 52.95-53.15) Hounsfield units (HU). Lowest median density was observed in segment IVb, significantly lower compared with other segments (p<0.05). Highest median segmental density was observed in segment V compared to other segments (p<0.05). Segments V, VI and VIII had higher median densities compared with grand median hepatic density (i.e. 53.05; whereas median densities of segments II, III and VII were not significantly different from the grand median. CONCLUSION: Liver biopsy taken from segments II, III and VII are likely to be the most representative of overall fat deposition.