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Fatty liver

  • Focal fatty infiltration tends to have straight, well-defined margins between normal liver
  • Fat infiltration is confined to segments and subsegments
  • Similarly focal sparing can simulate mass lesions, but again is typically confined to segments and subsegments reflecting vascular flow
NECT
  • Normal liver attenuation: 50-65 HU (8-10 HU more than spleen)
    • Steatosis: Absolute liver attenuation ≤ 40 HU or at least 10 HU less than that of spleen
  • Focal nodular fatty infiltration: Low attenuation
    • Common location: Adjacent to falciform ligament
    • Due to nutritional ischemia at vascular watershed area
CECT
  • Attenuation measurements and comparisons are less reliable than NECT
    • Dependent on timing relative to contrast administration
    • On venous-phase or delayed CECT, steatotic liver is usually > 35 HU less dense than spleen
  • Normal vessels course through fatty infiltration