multifokale noduläre Steatosis hepatis

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.


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.


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 .


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 .


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


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
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