J Korean Diabetes.  2017 Jun;18(2):88-101. 10.4093/jkd.2017.18.2.88.

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

• Kim KJ
• Kim SU
• Chung YE
• Kim CO

• KMID: 2385570
• DOI: http://doi.org/10.4093/jkd.2017.18.2.88

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.

Keyword

Computed tomography; Fatty liver; Liver fibroscan; Magnetic resonance spectroscopy; Ultrasonography

MeSH Terms

Biopsy
Diabetes Mellitus, Type 2
Diagnosis
Fatty Liver
Hemorrhage
Humans
Liver
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Non-alcoholic Fatty Liver Disease*
Prevalence
Ultrasonography

Figure

• 

  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.

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