Multifocal nodular hepatic steatosis

Multifocal

nodular hepatic steatosis. CT showed more nodular hepatic lesions than those visualized in previous CTs. The radiologic appearance of these lesions had not changed but their size had significantly increased.

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Multifocal

nodular hepatic steatosis. Multiple hyperechoic and well-defined nodular lesions which corresponded to focal nodular steatosis. Core-needle biopsy confirmed the presence of macrovesicular steatosis within these lesions.

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Multifocal

nodular hepatic steatosis. Multiple nodular hepatic lesions clearly depicted on T1-weighted out-of-phase images. These lesions were not visible on T1 weighted in-phase images.

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Multifocal

nodular hepatic steatosis. Multifocal nodular hepatic lesions, mainly hypodense (red arrows) associated to some diffuse hypodense hepatic areas (black arrows). Note the splenic haematoma and an artefact in the lower pole of the spleen (embolization).J.A Prat-Matifoll, Vall Hebron Hospital, Radiology Department

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Multifocal

nodular hepatic steatosis. Multiple nodular lesions were clearly depicted on a T1-weighted out-of-phase image but were slightly hyperintense on a T2-weighted image. These lesions were not visible in diffusion or ADC. No contrast enhancement was observed.J.A Prat-Matifoll, Vall Hebron Hospital, Radiology Department

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Multifocal hepatic steatosis (also known as multifocal nodular hepatic steatosis) is the uncommon finding of multiple foci of focal fat in the liver mimicking - and at times being confused with - hepatic metastases.

Epidemiology

Risk factors

Conditions that increase one's risk of developing multifocal hepatic steatosis are identical to other forms of steatosis:

diabetes mellitus
obesity
chronic alcohol excess
exogenous steroids
drugs (amiodarone, methotrexate, chemotherapy)
IV hyperalimentation

Clinical presentation

Multifocal hepatic steatosis is usually an incidental imaging finding.

Pathology

See focal hepatic steatosis.

Radiographic features

The steatotic lesions vary from several millimeters to centimeters in size . They lack mass effect (i.e. they do not displace hepatic vessels or other structures) and display no internal vascularity .

Ultrasound

Focal steatosis on ultrasound usually forms a well-circumscribed area of echogenicity without mass effect. Acoustic shadowing may be present. Using color Doppler usually shows a complete absence, or only slight flow, within the affected liver .

CT

Focal steatosis on CT usually forms a low density lesion without mass effect or visible enhancement.

MRI

The most discriminating finding on MRI is the loss of intralesional signal on the out-of-phase sequence.

Signal characteristics

T1: hyperintense signal
T2: mildly increased signal
T1 C+ (Gd-EOB-DTPA): on the hepatobiliary phase (20 minutes), uniform enhancement of the liver across both affected and unaffected regions
IP/OP
- in-phase: hyperintense signal within the steatotic foci
- out-of-phase: loss of signal
DWI/ADC: no abnormal restriction is usually seen