focal fatty sparing adjacent to the gallbladder

https://www.mdpi.com/openaccess. Of these patients, 103 individuals were treated with an oxaliplatin-containing regimen, which is FOLFOX. CT arteriography and dynamic magnetic resonance images were useful for diagnosing this metastatic tumor. Kreft, B.P. ; Hurley, D.L. Preoperative CT scan and magnetic resonance (MR) imaging in 1993 had shown a slightly fatty liver and no metastasis. Miyake, K.; Hayakawa, K.; Nishino, M.; Morimoto, T.; Mukaihara, S. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. ; 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. Curr Gastroenterol Rep 17:12, Barthelmes L, Tait IS (2005) Liver cell adenoma and liver cell adenomatosis. (2010) Prevalence and risk factors of focal sparing in hepatic steatosis. interesting to readers, or important in the respective research area. In many cases, the phenomenon is believed to be related to the hemodynamics of a third inflow . ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. At least one of the lesions of interest was found in a total of 6851 patients (15.1% of the population examined). 2 test for categorical variables, unless the sample size was too small, in which case Fishers exact test was used. Focal fatty sparing of the liver | Radiology Reference Article ; Compton, C.C. Kim B, Oh J, Nam K et al. A total of 44.9% of these patients were outpatients and 55.1% inpatients. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). (2011) ISBN: 9781451118124. Cholecystitis - Symptoms and causes - Mayo Clinic Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. Hepatic pseudolesion: appearance of focal low attenuation in the medial segment of the left lobe at CT arterial portography. Nodular focal fatty sparing of liver sometimes is a mimicker of malignant lesion, especially metastatic tumor. Non-enhanced CT on admission in 1996, showing a wedge-shaped hyperdense area in the anterior segment of the right lobe. Current Oncology | Free Full-Text | Evaluation of Adjuvant Chemotherapy Recently, some reports have mentioned the appearance of a focal sparing area in the generalized fatty liver. 2021, 28, 3030-3040. (c) Opposed-phase MR images show a hyperintense area in the entirely hypointense liver (TR = 120, TE = 2.1). 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). Allison Forrest, Sam Afshari, Naiim Ali, Ahmad Alizadeh, Fariborz Mansour-Ghanaei, Soheil Hassanipour, Carmelo Corallo, Joshua Bell, Raneem Albazaz, Feiqian Wang, Kazushi Numata, Shin Maeda, Maria Stella Franz, Antonio Bottari, Carlo Saitta, Cheng Fang, Silvia Bernardo, Paul S. Sidhu, Federica Vernuccio, Roberto Cannella, Giuseppe Brancatelli, Antonio Corvino, Fabio Sandomenico, Orlando Catalano, Abdominal Radiology On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). Case of Liver Metastasis from Colon Cancer Masquerading as Focal Friedman, S.L. Introduction. 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). ; Lee, H.W. Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. The prevalence data published so far on hepatic adenoma are between 0.4% and 1.7%. Wolfgang Dhnert. Abdom Radiol 41, 2532 (2016). The highest prevalence figures were reported from autopsy and CT studies [12, 15, 19, 28]. Kaltenbach, T.EM., Engler, P., Kratzer, W. et al. 1, 2, 3 Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. Gandolfi et al. For more information, please refer to Terminology Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Findings and Implications of Focal Fatty Sparing of the Liver at Follow This distribution is the same as that seen in focal fatty sparing and is thought to relate to variations in vascular supply. ; Hanafi, I.; Al Zoubi, M.; Bdeir, Z.; Yassin, M.A. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. The size and age structure of the respective study populations, as well as the quality of the ultrasound equipment used, need to be considered here. ; Szczepaniak, L.S. In order to be human-readable, please install an RSS reader. Fan, R.; Wang, J.; Du, J. Results that were incomplete or ambiguous were excluded from this study. methicillin-resistant Staphylococcus aureus, Oxford University Press is a department of the University of Oxford. positive feedback from the reviewers. ; Lee, K.S. 2023 Springer Nature Switzerland AG. Glucocorticoids and non-alcoholic fatty liver disease. Focal gallbladder wall thickening (differential). no financial relationships to ineligible companies to disclose. 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. 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. Available online: Goldberg, D.; Ditah, I.C. (1991) Natural history of hepatic haemangiomas: clinical and ultrasound study. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). Become a Gold Supporter and see no third-party ads. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). An association between the occurrence of benign focal liver lesions and age was observed. It was suggested that this fibrotic liver tissue corresponded to the area of focal sparing seen on CT and MR images. Normal vessel-like structures were not observed in this abnormal area. Unable to process the form. The authors declare no conflict of interest. (b) CT during arterial portography clearly shows a wedge-shaped hypointese area in the anterior segment, indicating ischemia, due to intrahepatic portal vein blockade. Naturally, these cannot be recorded in retrospective ultrasound prevalence studies. Multiple FNHs were rare; the prevalence of solitary FNHs was 88.9% (n=72), and the average size was 51.6mm. and Strunk et al. Schumacher, J.D. Is hepatic steatosis reversible? Doumas, M.; Imprialos, K.; Dimakopoulou, A.; Stavropoulos, K.; Binas, A.; Athyros, V.G. Canadian Liver Foundation 2017 [cited 2020 May 24]. (2011) Focal nodular hyperplasia-like lesions in patients with cavernous transformation of the portal vein: prevalence, MR findings and natural history. The gender distribution of hemangioma was almost balanced, with 53.4% (n=879) women/46.6% (n=761) men. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in It is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. 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. According to existing literature, the frequency of hepatic steatosis development in CRC patients receiving 5-FU ranges from 3047% [, The use of oxaliplatin as part of the chemotherapy regimen did not appear to affect the risk of steatosis in our analysis, barring perhaps a non-significant, mildly lower rate of steatosis development in those receiving oxaliplatin compared to those on treatment regimens not containing oxaliplatin. 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. In terms of the abnormal finding in the anterior segment, non-enhanced CT suggested focal sparing and sonography suggested a metastatic tumor. Peppercorn, P.; Reznek, R.; Wilzon, P.; Slevin, M.L. ; Saeian, K.; Lalehzari, M.; Aronsohn, A.; Gorospe, E.C. Nodular focal fat sparing of liver mimicking hepatocellular - LWW Introduction: Focal fatty sparing is a manifestation of fatty liver. Association between a focal spared area in the fatty liver and The purpose of this study was to investigate whether fatty sparing adjacent to the gallbladder fossa is related to efferent blood flow from the gallbladder wall. J Clin Ultrasound 21:115118, Gaines PA, Sampson MA (1989) The prevalence and characterization of simple hepatic cysts by ultrasound examination. 84.2% (n=16) of patients with adenoma were women. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. At further existing unclarity, an MRI was performed in unclear findings at MRI puncture of the lesions were attempted. Through higher performance ultrasound equipment and the introduction of contrast-enhanced ultrasound, the diagnosis of FNH can nowadays be made with higher sensitivity and specificity [31]. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients, https://doi.org/10.1007/s00261-015-0605-7, Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma, Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran, Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre, Application of new ultrasound techniques for focal liver lesions, Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules, Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography, Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability, Uncommon imaging evolutions of focal liver lesions in cirrhosis, Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art, http://creativecommons.org/licenses/by/4.0/. 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%. Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. Such atypical cases may simulate neoplasms on CT scans (1,810). 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. ; Perlman, S.J. The age-dependent frequency of hepatic steatosis and the related prevalence of focal fatty sparing in patients with hepatic steatosis were also determined (Table2). Lee, M.C.M. J Ultrasound Med 14:649652, Feldman M (1958) Hemangioma of the liver. 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. PubMed This proved that the lesion was an adenocarcinoma and right hepatectomy was performed on July 4, 1996. Non-enhanced CT demonstrated a fatty liver associated with a wedge-shaped hyperdense area which occupied almost all of the anterior segment of the right lobe (Fig. 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]. Canadian Cancer Societys Advisory Committee on Cancer Statistics. 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]. 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). 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. The mean size was 39.0mm (Table3). The youngest patient group, under 30years of age, was scarcely affected, with an age-specific prevalence of 0.8% (n=21). 1. Inclusion criterion for this analysis was a positive sonographic diagnosis of benign focal liver lesions (hepatic cysts, hepatic hemangioma, FNH, hepatic adenoma and focal fatty sparing; Figs. In line with our results, all studies reported a higher prevalence of hepatic cysts with increasing age [19, 22, 23, 30]. 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. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. This research received no external funding. ; Lawson, T.L. 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. ; Packard, C.J. 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. Gut 32:677680, Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D (1993) Ecographic epidemiology of non-parasitic hepatic cysts. Furthermore, there is currently a lack of medical treatment for any population affected by steatosis, regardless of etiology, although a recently published population-based study suggests that statins may confer protective benefits against the development of steatosis. Obika, M.; Noguchi, H. Diagnosis and evaluation of nonalcoholic fatty liver disease. Please note that many of the page functionalities won't work as expected without javascript enabled. 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. The largest measured cyst diameter averaged 22.3mm. Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. 377/13). 4. J.J.K. PubMed [Focal sparing around the gallbladder in fatty liver: an - PubMed Kammen B, Pacharn P, Thoeni R et al. In relation to the CT, MRI, and autopsy studies, our prevalence is in the mid to lower third of the range. Imaging modalities included contrast-enhanced abdominal CT, abdominal ultrasound, and liver or abdominal MRI. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. Editors Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. With only 19 cases and hence a prevalence of 0.04%, hepatic adenoma was the rarest of the liver lesions we investigated. PubMedGoogle Scholar. designed the study and conducted data collection. Ultraschall Med 17:175178, Article ; Kim, T.K. Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. In the past 10years, comparatively few ultrasound-based studies have appeared on this subject [69]. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. "Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer" Current Oncology 28, no. Recognition of this finding is important to prevent the erroneous belief that the region of sparing is itself a mass. (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Extramedullary hematopoiesis (EMH) in the liver allograft presenting 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 [. J Clin Pathol 39:183188, Article Focal fatty liver (FFL) or focal steatosis is localised or patchy process of lipid accumulation in the liver. (d) In-phase MR images show a hypointense area in the entirely hyperintense liver (TR = 120, TE = 4.2). Grieco, A.; Forgione, A.; Miele, L.; Greco, A.V. Visit our dedicated information section to learn more about MDPI. According to histological examination of resected specimens of the colon, the tumor had invaded as far as the subserosal layer, and all of 24 extirpated lymph nodes were cancer-free. ; Laurie, J.A. Other variables included clinical data pertaining to their cancer and variables that may influence steatosis development, such as tumour location, whether primary surgical resection was performed, pelvic radiation status, steroid use, statin use, alcohol consumption, and duration and type of adjuvant chemotherapy received. ; Gupta, R.K. ; Mechanick, J.I. Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously) focal fatty infiltration , represents small areas of liver steatosis. Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. The finding of a FNH or an adenoma is rarely a random discovery. 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. Ultraschall Med 31:3742, Varbobitis IC, Pappas G, Karageorgopoulos DE, Anagnostopoulos I, Falagas ME (2010) Decreasing trends of ultrasonographic prevalence of cystic echinococcosis in a rural Greek area. AJR Am J Roentgenol. Tanja Eva-Maria Kaltenbach and Phillip Engler have contributed equally to this work. 1); enhanced CT was not done. Focal fatty infiltration increases the echogenicity of the liver on US images and produces low attenuation on CT images. Since fat is intracellular in liver steatosis,and not in the extracellular matrix,using infiltration to describe it is factually incorrect. Current Oncology. Sonography shows an elliptical mass surrounded by a halo, indicated by the white wedges, in the anterior segment of the right lobe; its internal echogenicity is irregular. However, it occasionally creates some problems in the diagnosis of hepatic mass lesions. The prevalence figures of the two ultrasound-based studies for FNH were 0.8% and 1.8% and lie below the figures of between 1.8% and 3.2% reported from CT, MRI, or pathological investigations [1215]. 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. Conversely, some cases of true hepatic masses have been reported to mimic fatty infiltration (11) or focal sparing (12). The study was conducted in accordance with the Guidelines of the Declaration of Helsinki and the recommendations of Good Clinical Practice. Moertel, C.; Fleming, T.; Macdonald, J.; Haller, D.G. Joy, D.; Thava, V.R. Google Scholar, Chiche L, Adam JP (2013) Diagnosis and management of benign liver tumors. The heart and lungs were clear to auscultation and palpation of the liver revealed no abnormality. ; Kachura, J.J.; Vlachou, P.A. Focal sparing shows oppsite patterns on US and CT: decreased echogenicity on US images and high attenuation on CT images. The mean age of patients at the time of the investigation was 5618.1years (range: 4months105years). described a higher prevalence of hemangioma in middle aged or older patients, while Rungsinaporn et al. ; 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. 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. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. All lesions were examined also by color and power Doppler ultrasound. Am J Clin Pathol 29:160162, Rungsinaporn K, Phaisakamas T (2008) Frequency of abnormalities detected by upper abdominal ultrasound. Our measured mean cyst size of 2.2cm corresponds to the values published in the literature [19, 22, 23, 30]. At the time the article was created Frank Gaillard had no recorded disclosures. The understanding of hepatic adenoma has changed fundamentally in recent years [32, 33]. NAFLD is considered the hepatic manifestation of metabolic syndrome and is associated with obesity, dyslipidemia, and type 2 diabetes mellitus. The used probes are C2-5, C1-5, and C1-6 (16MHz). Focal fatty sparing of the liver is the localized absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. 5). Disclaimer/Publishers Note: The statements, opinions and data contained in all publications are solely Histopathology of the resected liver tumor. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Onaya et al. An evidence-based review of statin use in patients with nonalcoholic fatty liver disease. ; Tanimoto, A.; Baba, Y.; Zhao, L.; Chen, J.; Middleton, M.S. Only a few studies have determined the prevalence of FNH, hepatic adenoma and focal fatty sparing. 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. You are accessing a machine-readable page. Garvey, W.T. the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, The mean age was 64.7years. 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. 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. most exciting work published in the various research areas of the journal. Capecitabine: An overview of the side effects and their management. 1.1.11 Fatty liver and focal sparing | Ultrasound Cases When located in characteristic locations then there is usually little difficulty in making the correct diagnosis. ; Scott, B.B. Hepatic toxicity associated with fluorouracil plus levamisole adjuvant therapy. ; Oliva, I.B. ; Dobbins, R.; Nuremberg, P.; Horton, J.D. 3. A chest X-ray on admission showed no abnormality. 5. Ultrasound results typical of adenomas and FNH were only included in the evaluation, if these had been confirmed by further imaging or histology. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). Solitary cysts were found in 62.8% (n=1652) of cases. 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 ().This condition, called focal sparing, can occur in . 1. Wolfgang Kratzer. For continuous variables, the mean and standard deviation were calculated, while categorical attributes were presented in absolute and relative frequencies. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive 2. It is therefore the method of choice in primary diagnostic investigations in most specialist areas of medicine, but especially for imaging the abdomen [1]. 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). In addition, many studies on the prevalence of benign space-occupying lesions of the liver were conducted in the 1990s or earlier, i.e., at a time when the image quality of the ultrasound devices used was greatly inferior [17, 2123].

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