Radiologic Evaluation of Non-Alcoholic Fatty Liver Disease in Diabetic Patient

Kwang Joon Kim; Seung Up Kim; Yong Eun Chung; Chang Oh Kim

doi:10.4093/jkd.2017.18.2.88

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Kim, Kim, Chung, and Kim: Radiologic Evaluation of Non-Alcoholic Fatty Liver Disease in Diabetic Patient

Focused Issue

The Journal of Korean Diabetes 2017; 18(2): 88-101.

Published online: 30 June 2017

DOI: https://doi.org/10.4093/jkd.2017.18.2.88

Radiologic Evaluation of Non-Alcoholic Fatty Liver Disease in Diabetic Patient

Kwang Joon Kim¹, Seung Up Kim², Yong Eun Chung³, Chang Oh Kim¹

¹Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

²Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

³Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Chang Oh Kim. Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea, cokim@yuhs.ac

Received 10 May 2017 Accepted 29 May 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Non-alcoholic fatty liver disease (NAFLD), traditionally considered as a disease of hepatologists, has recently become a major concern in patients with type 2 diabetes mellitus (T2DM) as T2DM seems to worsen the course of NAFLD and vice versa. Furthermore, the increasing prevalence of NAFLD in T2DM and the complex mechanisms between these two diseases make physicians caring for patients with T2DM face many uncertainties in the diagnosis of NAFLD. Although the liver biopsy is considered as the gold standard of the diagnosis of NAFLD so far, it has several limitations such as infection, bleeding and cost. Hence, radiologic evaluations have been increasingly accepted as noninvasive alternatives to liver biopsy. Currently, 4 major imaging tools are available for measuring liver fat, including ultrasonography, computed tomography, magnetic resonance imaging and liver fibroscan. This article will describe these methods used to evaluate hepatic steatosis in patients with T2DM, including the diagnostic accuracy, limitations, and practical applicability.

Keywords: Computed tomography, Fatty liver, Liver fibroscan, Magnetic resonance spectroscopy, Ultrasonography

Figures and Tables

Fig. 1

Measuring hepatic steatosis by computed tomography (CT) scan (Hounsfield unit, HU). (A) With non-alcoholic fatty liver disease (NAFLD). NAFLD: liver HU was lower than 60 (5). So, liver/spleen HU ratio was below 0.9 (0.09). (B) Without NAFLD. Normal patient: liver HU was higher than 60 (62). Hence, liver/spleen HU ratio was higher than 0.9 (1.16).

Fig. 2

Measuring hepatic steatosis by magnetic resonance imaging (MRI).

MRS, magnetic resonance spectroscopy.

Fig. 3

Basic concept of liver fibroscan.

CAP, controlled attenuation parameter.

Fig. 4

Measurement of controlled attenuation parameter (CAP).

Fig. 5

Controlled attenuation parameter (CAP) result.

Table 1

Characteristics of MR techniques for diagnosing hepatic steatosis

MR, magnetic resonance; PPV, positive predictive value; NPV, negative predictive value; ROC, receiver operating characteristic; GRE, gradient echo; DE, dual echo; TE, triple echo; MRI, magnetic resonance imaging.

Table 2

Comparison of imaging techniques for evaluating hepatic steatosis

US, ultrasonography; CT, computed tomography; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; CAP, controlled attenuation parameter; DM, diabetes mellitus.

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