PART I: SUMMARY
PART II: TEMPORARY TRANSLATION
PART I: SUMMARY OF KNOWLEDGE ABOUT MULTIPLAYER CATEGORIES
GENERAL CHARACTERISTICS (General features):
- Mild enlarged liver (mild hepatomegaly) in 75% of cases
- Sound absorption level / signal (attenuation / signal) from the liver to the fat
- The preserved liver area does not become fatty (focal fatty sparing)):
- Appears as Geographic regions
- Location characteristic (locations characteristic)): Along pit / gallbladder bed (gallbladder fossa) OR next door the porta hepatis (lower lobe IV: segment IV), the falciform ligament OR nsubcapsular parenchyma
- Not available block effect (mass effect)
- Not available deformation of blood vessels (distortion of vessels)run over
RADIOGRAPHIC FEATURES IMAGE CHARACTERISTICS:
X-ray
On film Plain (abdominal) radiograph / an X ray film / a radiograph) see: Radiolucent liver sign
Ultrasound for diffuse fatty liver disease
- Echognicity of increased liver parenchyma: Compare with the renal cortex OR with the spleen (when present parenchymal kidney disease / renal parenchymal disease: laconic parenchymal disease).
Increased response relative compare to renal cortex (laconic cortex), spleen.
- CLASSIFICATION OF INFLUENOUS PEA (Grading of diffuse hepatic steatosis):
Grade I: Diffusely increased hepatic echogenicity but echoes around the portal vein and feedback around diaphragmatic echogenicity still see.
Grade II: diffuse increase in liver echogenicity obscuring) periportal echogenicity but the diaphragm response remains appreciable.
Grade III: diffuse hepatic echogenicity, obscuring echoes around the portal vein as well as diaphragm
- The preserved liver area is not infected with fat (focal fatty sparing): The echogenicity is significantly reduced compared to that of the surrounding fatty parenchyma.
Computed tomography (CT):
- Decreased attenuation of the liver in the previous picture injection (precontrast )and images portal venous phase imaging after injection.
- The preserved liver area is not infected with fat (focal fatty sparing):
Does not have the same properties as diffuse GNM.
Appears as hyperattenuating geographic regions)
PART II: TEMPORARY TRANSLATION
1. Plain radiograph (X-ray film not prepared)
Radiolucent liver sign: liver soft-tissue outline becomes difficult to appreciate.
Lymphatic liver markers: the soft tissue shade of the liver becomes difficult to evaluate. Explain: X-ray film, placed behind the body part to be taken. The X-ray machine shines an X-ray through this body part. X-rays that meet the film will form an image. The more X-rays that reach the film, the darker the recorded image. When passed through the body, the X-ray is absorbed proportional to the density of the tissue that the beam penetrates. So the solid parts of the body (high density) block a lot of X-rays (ie this structure Contrast / non-optical:radiopaque) will give white shapes (eg bones) while parts hollow or gas-filled body (small density) (ie this structure no contrast / optical: radiolucent) will be black (eg lungs). Soft tissues (such as muscles or solid organs in the body) will show different levels of gray depending on their intensity.
Ultrasound (Ultrasound)
1.1.Seatosis manifests as increased echogenicity and beam attenuation. This results in:
Fatigue is manifested by an increase in echogenicity and a decrease in the beam, which leads to:
- laconic cortex appeared relatively hypoechoic compared to the liver parenchyma (normally liver and laconic cortex are of a similar echogenicity)
The renal cortex appears to be hypoechoic relative to the liver parenchyma (normally, liver and renal cortex have similar echoes)
- increased echogenicity relative to the spleen, when there is parenchymal laconic disease
increased echogenicity compared with spleen, when there is parenchymal kidney disease.
- absence of the normal echogenic walls of the portal veins and hepatic veins
Disappears the normal echogenic walls of the portal and hepatic veins
- important not to assess vessels running perpendicular to the beam, as these produce direct reflection and can appear echogenic even in a fatty liver
it is important not to evaluate blood vessels running perpendicular to the beam, as they produce a direct negative feedback and can appear as a response even in fatty liver.
- poor visualization of deep portions of the liver
It is difficult to see deep parts of the liver
- poor visualization of the diaphragm
It is difficult to see the diaphragm
1.2. Grading of diffuse hepatic steatosis on ultrasound has been used to communicate to the clinician about the extent of fatty changes in the liver.
Ultrasonic diffuse fatty liver classification has been used to inform clinicians of the degree of fatty liver in the liver.
2. GRADE (degree)
grade I: diffusely increased hepatic echogenicity but periportal and diaphragmatic echogenicity is still appreciable
Grade I: diffuse hepatic echogenicity, but echogenicity around the portal vein and diaphragm is still visible.
grade II:diffusely increased hepatic echogenicity obscuring periportal echogenicity but diaphragmatic echogenicity is still appreciable
Grade II: diffuse hepatic echogenicity, obscuring echoes around the portal vein, but diaphragmatic echoes are still visible.
grade III: diffusely increased hepatic echogenicity obscuring periportal as well as diaphragmatic echogenicity
Grade III: diffuse hepatic echogenicity, obscuring echoes around the portal vein as well as diaphragm
1.3. PRACTICAL POINTS (Clinical Notes):
It is important not to fall into the pitfall that all diffusely echogenic livers are fatty, other pathologies may produce identical appearances, including cirrhosis.
It is important not to fall into the trap that all cases of diffuse hepatic echogenicity are fatty, other pathologies that may produce identical manifestations, including cirrhosis.
Some suggest that visual grading of hepatic steatosis is subject to a wide interobserver and intraobserver variability.
Some argue that the visual classification of fatty liver status depends on a large variation of [bản thân] observe and between observers.
3. Sonoelastography: can assess the degree of accompanying fibrosis by measuring tissue stiffness (FibroScan®, acoustic radiation force impulse).
Tissue elastography can assess the degree of associated fibrosis by measuring tissue stiffness (FibroScan®, negative radiation impulse). Explain: Tissue elasticity ultrasound in evaluation level Cirrhosis called FibroScan®, also known as transient elasticity rating (transient elastography)
There is also a histological three point scale for grading severity of non-alcoholic steatohepatitis. These two grading systems are not currently correlated.
There is also a three-point histological scale for classifying the severity of non-alcoholic steatohepatitis. These two classification systems are currently not correlated.
4. CT (computed tomography): Computer tomography.
Widespread fatty steatosis reduces the density of the liver.
(Hepatic attenuation on CT, reflected by Hounsfield values, depends on a combination of factors including the presence or absence, as well as the phase, of IV contrast administration. Allowing for all these factors, the mean unenhanced attenuation value is around 55 HU. Several intrinsic liver pathologies can cause a diffuse change in liver attenuation with increased hepatic fat being the most prevalent.)
The density of the liver on CT, as reflected by Hounsfield values, depends on a combination of factors including presence or absence, as well as the stage of intravenous contrast use. Taking all of these factors into account, the average density without contrast was about 55 HU. Certain liver conditions can cause diffuse changes in the proportion of the liver with which increased liver steatosis is the most common / common.
- On noncontrast CT, moderate to severe steatosis (at least 30% fat fraction) is predicted by:
On a CT without injection, moderate to severe steatosis (at least 30% fat) was predicted by:
relative hypoattenuation: liver attenuation lower than 10 HU less than that of spleen.
Relative liver density decrease: the liver density is less than 10 HU less than that of the spleen.
absolute low attenuation: liver attenuation lower than 40 HU.
absolute low density: liver density less than 40 HU.
- In comparison, contrast enhanced CT is poorly predictive of steatosis due to variation in both hepatic absolute enhancement and relative enhancement compared to spleen depending on contrast administration protocol, scan timing, and patient factors affecting contrast circulation. I proposed:
Compared to conventional CT, contrast-based CT has poor prognosis of steatosis due to changes in both the absolute and relative degree of liver versus spleen contrast depending on the protocol (regimen) used Contrast drug, duration of scan, and patient factors influencing contrast agent circulation. However, several criteria for diffuse hepatic steatosis for CT contrast injection have been proposed:
liver-spleen differential attenuation (liver minus spleen) cutoffs ranging from less than -20 to less than -43 HU on portal venous phase, depending on injection protocol.
The proportion difference between liver – spleen (liver except spleen) has threshold from less than -20 to less than -43 HU in the portal phase, depending on the injection regimen.
- Focal fatty sparing: (appearing as qualitatively hyperattenuating geographic regions) along the gallbladder fossa or periphery of segment
Conserved liver area is free from steatosis (appears as an increase in density mapping) along the pit / bed of the gallbladder or the periphery of the lower lobe IV.
Reference source:
https://radiopaedia.org/articles/diffuse-hepatic-steatosis
Dr. VO HUONG – ANHVANYDS.
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