(1991) Natural history of hepatic haemangiomas: clinical and ultrasound study. He had undergone sigmoidectomy for well differentiated adenocarcinoma of the sigmoid colon on September 2, 1993 in our department. Ultraschall Med 17:175178, Article Gandolfi et al. Introduction: Focal fatty sparing is a manifestation of fatty liver. Conversely, some cases of true hepatic masses have been reported to mimic fatty infiltration (11) or focal sparing (12). Histological examination revealed that the tumor, a well differentiated adenocarcinoma, was surrounded by fibrotic tissue, and that this fibrotic tissue contained fewer fat vacuoles than the rest of the liver parenchyma (Fig. All ultrasonographic examinations were performed in the ultrasound unit by experienced physicians. 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. Simple hepatic cysts and hemangiomas are the most common focal liver lesions. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. https://doi.org/10.3390/curroncol28040265, Lee MCM, Kachura JJ, Vlachou PA, Dzulynsky R, Di Tomaso A, Samawi H, Baxter N, Brezden-Masley C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. Severe and Late Acute Liver Injury Induced by Capecitabine. However, while elevated levels of liver biochemical tests often correlate with a diagnosis of fatty liver, a high proportion of patients with NAFLD exhibit normal liver profiles, making these tests inappropriate diagnostic markers that may not have drastically impacted the findings presented in our study [. Baseline and . Conclusions The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion. Two further examinations were therefore performed to distinguish between these two types of lesion. These segments were rarely spared in patients with previous cholecystectomy. (2011) ISBN: 9781451118124. articles published under an open access Creative Common CC BY license, any part of the article may be reused without The research group of Koseoglu reported a prevalence of focal fatty sparing of up to 19.8 [18] Strunk et al. Other imaging techniques also demonstrated a wedge-shaped area which was difficult to distinguish from mere focal sparing in the fatty liver. Hepatology 50:481489, Thapar M, Grapp O, Fisher C (2015) Management of hepatic adenomatosis. The histological findings eventually revealed that the tumor, an adenocarcinoma, was surrounded by fibrotic tissue that mimicked focal sparing. The mean size was 39.0mm (Table3). 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). Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. Solitary cysts were found in 62.8% (n=1652) of cases. Scand J Gastroenterol 50:355359, Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C (2013) Fortuitously discovered liver lesions. Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for ; Lee, K.S. Alkhouri, N. NASH and NAFLD: Emerging drugs, therapeutic targets and translational and clinical challenges. The finding of a FNH or an adenoma is rarely a fortuitous result. Variables found to be associated with both the exposure and outcome and thus, probably confounders, were selected as covariates based on a review of relevant literature. This condition, called focal sparing, can occur in diverse patterns. When located in characteristic locations then there is usually little difficulty in making the correct diagnosis. It is mostly idiopathic but it has been often related to obesity, diabetes mellitus, alcohol use, hepatitis, starvation, steroid therapy or parenteral nutrition [].The degree of the fatty infiltration can be focal, diffuse or patchy []. 1. ; Tanimoto, A.; Baba, Y.; Zhao, L.; Chen, J.; Middleton, M.S. Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. The role of statins in the management of nonalcoholic fatty liver disease. Schumacher, J.D. The Supportive Care Needs of Regional and Remote Cancer Caregivers, SOX2 and Bcl-2 as a Novel Prognostic Value in Hepatocellular Carcinoma Progression, https://doi.org/10.3390/curroncol28040265, https://www.mdpi.com/article/10.3390/curroncol28040265/s1, https://www.liver.ca/patients-caregivers/liver-diseases/fatty-liver-disease/, https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf, https://creativecommons.org/licenses/by/4.0/. Chalasani, N.; Younossi, Z.; Lavine, J.; Charlton, M.; Cusi, K.; Rinella, M.; Harrison, S.A.; Brunt, E.M.; Sanyal, A.J. Focal Fatty Infiltration of the Liver. Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. AJR Am J Roentgenol. CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. Mechanistic review of drug-induced steatohepatitis. For continuous variables, the mean and standard deviation were calculated, while categorical attributes were presented in absolute and relative frequencies. Advertisement intended for healthcare professionals, For reprints and all correspondence: Motohisa Kato, Second Department of Surgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500, Japan. The peak age for FNH occurred in the youngest patient group with 34.6% (n=28) of the diagnosed lesions and fell continuously with increasing age. ; Saeian, K.; Lalehzari, M.; Aronsohn, A.; Gorospe, E.C. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. ; Kachura, J.J.; Vlachou, P.A. ; Hobbs, H.H. All lesions were examined also by color and power Doppler ultrasound. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. The dynamic contrast enhancement techniques, CTA and dynamic MR imaging, showed irregular enhancement in the abnormal area, which indicated disappearance of the normal vessel structure and was quite useful for diagnosing the metastatic tumor. In rare cases, focal fatty sparing has also been described in other liver segments where, in the first instance, it is generally difficult to distinguish from malignant lesions and can hence pose considerable problems for a differential diagnosis [2426]. 2001;177(5):1035-9. congenital malformations and anatomical variants. We thank Ayesha Taqi and Aftab Malik for their generous help in the data collection process. Patients with focal fatty sparing are more often male and have a higher BMI and a larger liver than patients with nonalcoholic fatty liver disease without focal fatty sparing. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive Introduction. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). A characteristic location for focal hepatosteatosis is the medial segment of the left lobe of the liver ( segment 4) either anterior to the porta hepatis or adjacent to the falciform ligament 1. ; Francque, S.; Staels, B. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. 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%. PubMed The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. Part of Springer Nature. 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]. Histopathology of the resected liver tumor. Only a very few studies investigated the prevalence of FNH, hepatic adenoma, and focal fatty sparing. Sohn J, Siegelman E, Osiason A. The highest prevalence was found in younger women, and 86.4% (n=70) of all patients with FNH were females. 4. 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. In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean SD, 35.9 1.14 months). Wolfgang Dhnert. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 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. Eur J Radiol 61:3343, Vaidyanathan S, Horrow MM (2007) Case 6: diagnosis: focal fatty sparing of the caudate lobe mimicking a mass. 5). 2023 Springer Nature Switzerland AG. In general, the treatment of the underlying condition will reverse the findings. Zentralbl Chir 123:119123, CAS no financial relationships to ineligible companies to disclose. Sigler, M.A. There was also a hypoechoic mass in segment 6 of the liver measuring, 4.8 3.1 cm. Thus, in this study, we sought to describe the frequency of CAS in stage IIIII CRC patients and to determine the incidence of CAS in patients who were prevalent users of statins during their adjuvant chemotherapy. Geographic focal fat sparing, much like focal fat infiltration involves similar areas: gallbladder fossa, medial segment near the falciform ligament, and the porta hepatis (Fig 4 a).Nodular focal fat sparing presents as hypoechoic lesions in a diffusely echogenic liver and can be extremely difficult to differentiate from true mass lesions (Fig 4 b). Among various candidate drugs under investigation, statins have been considered as a potential therapeutic option, and were recently shown to effectively reduce the risk of NAFLD development in a large population-based study [, Colorectal cancer (CRC) consistently ranks as one of the leading causes of cancer-related deaths in Canada [. The aim of the study was to determine the sonographic prevalence of benign focal liver lesions on the basis of a population of hospital patients. ; Dzulynsky, R.; Di Tomaso, A.; Samawi, H.; Baxter, N.; Brezden-Masley, C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. As was already put forward as a possible explanation in the case of FNH, this could be due to the age of the study participants, the size of the patient population investigated, and the improved differentiation possibilities of modern ultrasound equipment. 1996-2023 MDPI (Basel, Switzerland) unless otherwise stated. Published values for the prevalence of hepatic hemangiomas range from 0.1% to 20.0% [6, 7, 10, 11] and those for hepatic cysts from 0.06% to 17.8% [7, 9, 10]. Andr, T.; Boni, C.; Mounedji-Boudiaf, L.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Zaninelli, M.; Clingan, P.; Bridgewater, J.; et al. https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. Vigano, L.; De Rosa, G.; Toso, C.; Andres, A.; Ferrero, A.; Roth, A.; Sperti, E.; Majno, P.; Rubbia-Brandt, L. Reversibility of chemotherapy-related liver injury. Kim B, Oh J, Nam K 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 Areas of focal fatty sparing of the liver adjacent to the gallbladder and porta hepatis, absolute value of liver density less than 40 HU or a density difference greater than 25 HU between the spleen and liver on contrast-enhanced CT, increased echogenicity of the liver, attenuation of the ultrasound wave, loss of definition of the diaphragm, and poor delineation of the intrahepatic architecture on ultrasound and signal drop of liver parenchyma on the T1 weighted out of phase imaging on MRI was considered fatty liver [, A log binomial regression model was used to calculate adjusted relative risks. 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. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. From six or more foci upwards, these were combined as more than five lesions. The information about lesion size was based on the maximum measurable diameter in each case. ; Davila, J.A. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. Abdom Radiol 41, 2532 (2016). It may include one or more of the following: supervised medical detox behavioral therapies, such as cognitive behavioral therapy or. 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. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Canadian Cancer Societys Advisory Committee on Cancer Statistics. 2021, 28, 3030-3040. View Frank Gaillard's current disclosures, View Raymond Chieng's current disclosures, see full revision history and disclosures, World Health Organisation 2001 classification of hepatic hydatid cysts, recurrent pyogenic (Oriental) cholangitis, combined hepatocellular and cholangiocarcinoma, inflammatory myofibroblastic tumour (inflammatory pseudotumour), portal vein thrombosis (acute and chronic), cavernous transformation of the portal vein, congenital extrahepatic portosystemic shunt classification, congenital intrahepatic portosystemic shunt classification, transjugular intrahepatic portosystemic shunt (TIPS), transient hepatic attenuation differences (THAD), transient hepatic intensity differences (THID), total anomalous pulmonary venous return (TAPVR), hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease), cystic pancreatic mass differential diagnosis, pancreatic perivascular epithelioid cell tumour (PEComa), pancreatic mature cystic teratoma (dermoid), revised Atlanta classification of acute pancreatitis, acute peripancreatic fluid collection (APFC), hypertriglyceridaemia-induced pancreatitis, pancreatitis associated with cystic fibrosis, low phospholipid-associated cholelithiasis syndrome, diffuse gallbladder wall thickening (differential), focal gallbladder wall thickening (differential), ceftriaxone-associated gallbladder pseudolithiasis, biliary intraepithelial neoplasia (BilIN), intraductal papillary neoplasm of the bile duct (IPNB), intraductal tubulopapillary neoplasm (ITPN) of the bile duct, multiple biliary hamartomas (von Meyenburg complexes). A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). All the cases of focal fatty sparing that we encountered were solitary findings in its typical location in liver segment IV in the region of the gallbladder bed. ; McKillop, J.H. In terms of the age distribution and average size, our results correspond to those of comparable studies [13, 19]. CT arteriogrphy (CTA) (Fig. Ultrasound results typical of adenomas and FNH were only included in the evaluation, if these had been confirmed by further imaging or histology. Joy, D.; Thava, V.R. Reversible hepatic steatosis in patients treated with interferon alfa-2A and 5-fluorouracil. All articles published by MDPI are made immediately available worldwide under an open access license. diffuse hepatic steatosis. interesting to readers, or important in the respective research area. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. There are no ultrasound studies on the prevalence of hepatic adenoma within a large patient population. Srensen, P.; Edal, A.; Madsen, E.; Fenger, C.; Poulsen, M.R. Current Oncology. The level of significance was set at =5%, and the p value was given to four decimal places. Of 269 patients, 76 (28.3%) had steatosis at baseline. Patients with polycystic liver diseases were excluded from this study. 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 Feature papers represent the most advanced research with significant potential for high impact in the field. The statistical calculations were carried out using the statistics software SAS 9.2 (SAS Institute Inc., Cary, North Carolina, USA) and the data evaluated using descriptive statistics. (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. 4) clearly showed a wedge-shaped hypointese area in the anterior segment, suggesting ischemia in this area. Focal sparing in diffusely fatty liver is a well recognized entity. We recently experienced a case of liver metastasis from colon cancer which appeared as a wedge-shaped hyperdense area on non-enhanced CT (computed tomography). Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. Following parameters were recorded and evaluated on the basis of the above-mentioned research question: positive/negative finding, nature of tumor, age and gender of the patient, number of foci (solitary, multiple), the respective ultrasound characteristics of the focus and size of the tumor (maximum diameter). The prevalence of 0.04% determined by us is considerably lower than that found in the previous studies. 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]. ; Reif, L.J. Piscaglia, F.; Svegliati-Baroni, G.; Barchetti, A.; Pecorelli, A.; Marinelli, S.; Tiribelli, C.; Bellentani, S. HCC-NADFL Italian Study Group. This is also ultimately reflected in the prevalence rates determined in the respective studies. permission is required to reuse all or part of the article published by MDPI, including figures and tables. ; Hazlehurst, J.M. CT during arterial portography (CTAP) (Fig. Habib, M.B. 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. 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. Through the division into four different genotypic subtypes, new aspects have emerged concerning prevalence and clinical presentation. Overall, more adenomas were diagnosed in the younger patient groups under 50years of age than in the older ones. calculated a value of 9.05% in a random population collective [8]. It is likely to have different pathogenesis than non-alcoholic steatohepatitis which is a diffuse process. The liver was examined in inter- and/or subcostal planes with a fan-like motion allowing assessment of both the hepatic parenchyma and the intrahepatic bile ducts. ; Foley, W.D. Detection of hepatic steatosis on contrast-enhanced CT images: Diagnostic accuracy of identification of areas of presumed focal fatty sparing. The aim is to provide a snapshot of some of the Katsiki, N.; Mikhailidis, D.; Mantzoros, C. Non-alcoholic fatty liver disease and dyslipidemia: An update. Twelves, C.; Scheithauer, W.; McKendrick, J.; Seitz, J.F. ; Lee, H.W. Location. analyzed and interpreted the data. ; MacFarlane, P.W. 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, https://doi.org/10.1093/jjco/27.3.189. In line with our results, all studies reported a higher prevalence of hepatic cysts with increasing age [19, 22, 23, 30]. Hepatic cysts became more common with age. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. A characteristic location for focal hepatosteatosis is the medial segment of the left lobe of the liver (segment 4) either anterior to the porta hepatis or adjacent to the falciform ligament 1. The age-dependent frequency of hepatic steatosis and the related prevalence of focal fatty sparing in patients with hepatic steatosis were also determined (Table2). The gender distribution of hemangioma was almost balanced, with 53.4% (n=879) women/46.6% (n=761) men. 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. A full blood count on admission showed normal values. ; 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. An assessment of the safety and efficacy of statins in a randomized controlled cohort will allow for an accurate investigation into this phenomenon that contributes to a secondary health burden for the curative CRC patient population. Differential diagnosis Naturally, these cannot be recorded in retrospective ultrasound prevalence studies. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. 2014;8(2):219-23. congenital malformations and anatomical variants. Capecitabine: An overview of the side effects and their management. CT arteriography and dynamic magnetic resonance images were useful for diagnosing this metastatic tumor. Curr. The understanding of hepatic adenoma has changed fundamentally in recent years [32, 33]. Shepherd, J.; Cobbe, S.; Ford, I.; Isles, C.G. Am J Clin Pathol 29:160162, Rungsinaporn K, Phaisakamas T (2008) Frequency of abnormalities detected by upper abdominal ultrasound. (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. On average, women were aged 56.118.8years and men 55.917.4years. methods, instructions or products referred to in the content. (b) T2-weighted MR images show an irregularly shaped hypointense area in the anterior segment (TR = 2000, TE = 80). The number of focal lesions was considered separately up to a figure of five lesions. J Clin Ultrasound 21:115118, Gaines PA, Sampson MA (1989) The prevalence and characterization of simple hepatic cysts by ultrasound examination. Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis. World J Gastroenterol 19:31733188, Article At the time the article was last revised Jeremy Jones had no recorded disclosures. Based on these findings, this lesion was strongly suspected of being a metastatic tumor associated with focal sparing, and a fine-needle biopsy was performed under sonographic guidance on May 22, 1996. ; Laurie, J.A. 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).
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