Of these patients, 103 individuals were treated with an oxaliplatin-containing regimen, which is FOLFOX. Liver areas with reduced focal, rarely zonal accumulation of fat can occur in hepatic steatosis. The remaining 193 patients who did not have fatty liver at baseline were further divided by whether they received curative chemotherapy (, The characteristics of the two patient groups are outlined in, We found that 52 of 135 patients (38.5%) who received adjuvant chemotherapy developed steatosis within one year of follow-up, compared to 14 of 58 patients (24.1%) who did not receive chemotherapy (Relative Risk [RR] 1.57, 95% confidence interval [CI] 0.89 to 2.79) after adjustment for sex, BMI, type 2 diabetes mellitus, hyperlipidemia, and steroid use. Fatty Liver: Imaging Patterns and Pitfalls | RadioGraphics In conclusion, the present case was difficult to diagnose because the tumor was hidden within the area of focal sparing, and dynamic contrast enhancement techniques, including CTA, CTAP and dynamic MRI, were useful for diagnosis. Although standard MR sequences are less helpful for visualization and characterization of fatty infiltration, chemical shift images (opposed- and in-phase images) are quite useful for depicting fat distribution and assist the diagnosis of focal fatty infiltration or sparing (7). Close Figure Viewer Return to Figure Previous FigureNext Figure (c) Opposed-phase MR images show a hyperintense area in the entirely hypointense liver (TR = 120, TE = 2.1). Focal fat deposition and focal fatty sparing. Note: data are presented as frequency (percent), unless otherwise specified. 2001;177(5):1035-9. congenital malformations and anatomical variants. Editors select a small number of articles recently published in the journal that they believe will be particularly Women were somewhat more affected (56.1%, n=1477) than men (43.9%, n=1154). 4 and 5). CT during arterial portography (CTAP) (Fig. Findings and Implications of Focal Fatty Sparing of the Liver at Follow Lee, J.I. 57% of all liver lesions found by ultrasound are benign [5]. The gender distribution of hemangioma was almost balanced, with 53.4% (n=879) women/46.6% (n=761) men. Patients with polycystic liver diseases were excluded from this study. 84.2% (n=16) of patients with adenoma were women. CTAP showed a wedge-shaped ischemic area. Piscaglia, F.; Svegliati-Baroni, G.; Barchetti, A.; Pecorelli, A.; Marinelli, S.; Tiribelli, C.; Bellentani, S. HCC-NADFL Italian Study Group. This study was also limited in that many potentially useful clinical and demographic data such as duration of statin administration and lifestyle factors contributory to steatosis could not be collected due to the retrospective nature of the investigation. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. ; Kim, T.K. 2021. (2004) High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia. Directed acyclic graphs were used to identify a minimally sufficient set of covariates to control potential confounding in the final adjusted model (, Overall, 329 patients who were diagnosed with stage IIIII CRC at St. Michaels Hospital from 1 January 2006 to 1 January 2017 were assessed for eligibility. In our study cohort, we did not observe a significant difference in the risk of developing steatosis when comparing patients receiving oxaliplatin-containing chemotherapy compared to those on a 5-FU based regimen (RR 0.64, 95% CI 0.30 to 1.38) after adjusting for sex, BMI, type 2 diabetes mellitus, hyperlipidemia, and steroid use (, The demographics of 135 patients who were treated with chemotherapy were summarized based on statin administration status, shown in, Among patients who were on statins at the time of their adjuvant chemotherapy, 11 of 37 (29.7%) patients developed steatosis within one year; however, 41 of 98 (41.8%) patients who did not receive statin treatment developed steatosis. Br J Radiol 62:335337, Aubin B, Denys A, Lafortune M, Dry R, Breton G (1995) Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels. 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). ; Perlman, S.J. MDPI and/or The point estimate is consistent with moderately increased risk of steatosis, but with wide confidence intervals (, We then examined the 135 patients who received adjuvant chemotherapy. Google Scholar, Sanfelippo P, Beahrs O, Weiland L (1974) Cystic disease of the liver. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). 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. methods, instructions or products referred to in the content. CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. CAS was determined through a review of radiology reports, and images were reviewed by a single radiologist to maximize inter-rater reliability. Become a Gold Supporter and see no third-party ads. Unfortunately, we cannot compare our results on age and gender distribution or those concerning the average size of the hepatic adenoma with any of the studies available to us. All ultrasonographic examinations were performed in the ultrasound unit by experienced physicians. Eur J Radiol 54:388392, Vlk M, Strotzer M, Lenhart M, et al. 2023 Springer Nature Switzerland AG. 4. Extramedullary hematopoiesis (EMH) in the liver allograft presenting At least one of the lesions of interest was found in a total of 6851 patients (15.1% of the population examined). 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%. The diagnosis of FNH was confirmed primarily by CEUS. ; Cohen, J.C.; Grundy, S.M. Kratzer et al. Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer. It was suggested that the tumor caused this ischemia due to intrahepatic portal vein blockade. Focal gallbladder wall thickening (differential). At the time the article was last revised Jeremy Jones had no recorded disclosures. At the time the article was last revised Raymond Chieng had Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. 5. Such atypical cases may simulate neoplasms on CT scans (1,810). (12) reported that the basic points suggesting the presence of fatty infiltration are: 1, the abnormal area does not show an overall mass effect; 2, the vessels are normally distributed and are evident in the abnormal area. Gut 32:677680, Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D (1993) Ecographic epidemiology of non-parasitic hepatic cysts. Focal Fatty Sparing Usually Does Not Arise in Preexisting Nonalcoholic ; Van Hazel, G.; Wong, A.; Diaz-Rubio, E.; Gilberg, F.; Cassidy, J. Capecitabine versus 5-fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: Final results from the X-ACT trial with analysis by age and preliminary evidence of a pharmacodynamic marker of efficacy. It was most often found in the 51-60 years age group; the mean age of the patients with focal fatty sparing was 54.9 14.5 years. St. Michaels Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada, Medical Sciences Building, 1 Kings College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada, Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada, Lunenfeld-Tanenbaum Research Institute, 600 University Ave, Toronto, ON M5G 1X5, Canada. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Gastroenterol Res Pract 2015:749235, Khosa F, Warraich H, Khan A, et al. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. Joy, D.; Thava, V.R. Chalasani, N.; Younossi, Z.; Lavine, J.; Charlton, M.; Cusi, K.; Rinella, M.; Harrison, S.A.; Brunt, E.M.; Sanyal, A.J. We present the radiological features of this case and discuss how to arrive at a correct diagnosis. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive At surgery, the tumor was found to be exposed on the surface of the anterior segment, adjoining not the middle hepatic vein but the right hepatic vein. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-33796. You are accessing a machine-readable page. World J Gastroenterol 19:31733188, Article The prevalence of 0.04% determined by us is considerably lower than that found in the previous studies. Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. CAS The mean maximum measured size of the focal fatty sparing was 20.6mm. In our population, a maximum occurred at between 41 and 50years of age. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Introduction. 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 Eur J Clin Microbiol Infect Dis 29:307309, Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G (2014) Lets go out of the breast: prevalence of extra-mammary findings and their characterization on breast MRI. Ballestri, S.; Nascimbeni, F.; Baldelli, E.; Marrazzo, A.; Romagnoli, D.; Lonardo, A. NAFLD as a Sexual Dimorphic Disease: Role of Gender and Reproductive Status in the Development and Progression of Nonalcoholic Fatty Liver Disease and Inherent Cardiovascular Risk. The used probes are C2-5, C1-5, and C1-6 (16MHz). Case 19 - Nodular focal fatty sparing of the liver - Cambridge Core ; Szczepaniak, L.S. We thank Ayesha Taqi and Aftab Malik for their generous help in the data collection process. 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. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. Focal sparing in diffusely fatty liver is a well recognized entity. Sigler, M.A. The heart and lungs were clear to auscultation and palpation of the liver revealed no abnormality. permission is required to reuse all or part of the article published by MDPI, including figures and tables. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Part of Springer Nature. Location. Case of Liver Metastasis from Colon Cancer Masquerading as Focal (2011) Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. Findings and Implications of Focal Fatty Sparing of the Liver at Follow AJR Am J Roentgenol. In the past 10years, comparatively few ultrasound-based studies have appeared on this subject [69]. The highest prevalence figures were reported from autopsy and CT studies [12, 15, 19, 28]. Hepatomegaly (enlarged liver): Symptoms, causes, and treatment The data presented in this study are available on request from the corresponding author. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). R.D., A.D.T., H.S., N.B. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. AJR Am J Roentgenol. Radiology Review Manual. 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. 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. (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. 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. A Feature Focal fat sparing and liver mass were the 2 most probable differential diagnoses suggested for the mentioned lesion. For more information, please refer to ; Mechanick, J.I. The largest measured cyst diameter averaged 22.3mm. analyzed and interpreted the data. 1, 2, 3 It is therefore the method of choice in primary diagnostic investigations in most specialist areas of medicine, but especially for imaging the abdomen [1]. Our prevalence figure of 3.6% for hemangioma lies in the mid-range compared to the previously published results from ultrasound-based studies [6, 7, 9, 17]. Without continually carrying out new studies at regular intervals, no comparative statements concerning possible changes in the prevalence of benign focal liver lesions over time are possible. The aim is to provide a snapshot of some of the reported a higher prevalence of hepatic hemangioma in womenresulting that we were unable to corroborate with our data (Table3) [21, 29]. (2001) Incidence and significance of small focal liver lesions in MRI. The serum bilirubin and ammonia levels had recovered almost to normal by about five weeks after the operation and the patient was discharged on the 74th postoperative day. There are no ultrasound studies on the prevalence of hepatic adenoma within a large patient population. ; Neuschwander-Tetri, B.A. https://www.mdpi.com/openaccess. 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. ; Lee, H.S. ; Oliva, I.B. 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