The examinations were evaluated for the presence of a focal area of increased attenuation in the liver in locations where focal fatty sparing typically occurs: adjacent to the gallbladder fossa and in the medial segment of the left lobe near the porta hepatis. Preoperative CT scan and magnetic resonance (MR) imaging in 1993 had shown a slightly fatty liver and no metastasis. It is important for the subsequent diagnosis and therapy and the associated expended time and effort of the treating physician and the affected patientto say nothing of the related coststhat the focus visible on ultrasound is classified as reliably as possible [4]. ; Lee, K.S. For AJR Am J Roentgenol. In many cases, the phenomenon is believed to be related to the hemodynamics of a third inflow . Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. ; Siu, L.L. Following initial conception of the study, the authors retrospectively identified patients who were treated and followed up by a medical oncologist at St. Michaels Hospital, Toronto, Canada, between 1 January 2006 and 1 January 2017. This study sought to examine hepatic steatosis, an increasingly recognized health concern worldwide. A characteristic location for focal hepatosteatosis is the medial segment of the left lobe of the liver ( segment 4) either anterior to the porta hepatis or adjacent to the falciform ligament 1. Google Scholar, Collin P, Rinta-Kiikka I, Rty S, Laukkarinen J, Sand J (2015) Diagnostic workup of liver lesions: too long time with too many examinations. {"url":"/signup-modal-props.json?lang=gb"}, Gaillard F, Chieng R, Shah V, et al. CT-supported studies have reported the highest figures for prevalence [15, 19]. Following parameters were recorded and evaluated on the basis of the above-mentioned research question: positive/negative finding, nature of tumor, age and gender of the patient, number of foci (solitary, multiple), the respective ultrasound characteristics of the focus and size of the tumor (maximum diameter). Case 19 - Nodular focal fatty sparing of the liver - Cambridge Core Eur J Radiol 61:3343, Vaidyanathan S, Horrow MM (2007) Case 6: diagnosis: focal fatty sparing of the caudate lobe mimicking a mass. As was already put forward as a possible explanation in the case of FNH, this could be due to the age of the study participants, the size of the patient population investigated, and the improved differentiation possibilities of modern ultrasound equipment. Kreft, B.P. ; Kim, T.K. 57% of all liver lesions found by ultrasound are benign [5]. However, it can occur in other parts of the liver and show various shapes including a wedge, as was seen in the present case (7). Ultrasound Q 23:7980, Kester NL, Elmore SG (1995) Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. Patients with polycystic liver diseases were excluded from this study. On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). Unfortunately, we cannot compare our results on age and gender distribution or those concerning the average size of the hepatic adenoma with any of the studies available to us. It is mostly idiopathic but it has been often related to obesity, diabetes mellitus, alcohol use, hepatitis, starvation, steroid therapy or parenteral nutrition [].The degree of the fatty infiltration can be focal, diffuse or patchy []. This condition, called focal sparing, can occur in diverse patterns. Simple hepatic cysts and hemangiomas are the most common focal liver lesions. ; Tanimoto, A.; Baba, Y.; Zhao, L.; Chen, J.; Middleton, M.S. Association between a focal spared area in the fatty liver and In most cases, gallstones blocking the tube leading out of the gallbladder cause cholecystitis. The ultrasound results in a population of (n=45,319) hospital patients over a period of 10years were examined retrospectively and evaluated for the diagnosis of benign focal liver lesions [hepatic cysts, hepatic hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing]. Close Figure Viewer Return to Figure Previous FigureNext Figure The study was conducted in accordance with the Guidelines of the Declaration of Helsinki and the recommendations of Good Clinical Practice. The mean age of patients at the time of the investigation was 5618.1years (range: 4months105years). Google Scholar, Sanfelippo P, Beahrs O, Weiland L (1974) Cystic disease of the liver. In the case of hepatic cysts, the range of prevalence figures from CT, MRI, or autopsy studies is also much wider than that of the ultrasound-based studies [5, 10, 15, 19, 30]. ; Mechanick, J.I. In general, the treatment of the underlying condition will reverse the findings. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. Browning, J.D. In comparison with CT, MRI, and autopsy studies, which show a far higher range of prevalence, our figure is in the lower third [10, 11, 19, 20]. The relative risk of developing steatosis was not significantly different regardless of statin therapy status at the time of adjuvant chemotherapy (RR 0.45, 95% CI 0.10 to 2.75) after adjusting for sex, BMI, type 2 diabetes mellitus, and hyperlipidemia (, In the present study, the adjusted relative risk of adjuvant chemotherapy reflected a moderately increased risk of steatosis, although the confidence intervals were wide. The Supportive Care Needs of Regional and Remote Cancer Caregivers, SOX2 and Bcl-2 as a Novel Prognostic Value in Hepatocellular Carcinoma Progression, https://doi.org/10.3390/curroncol28040265, https://www.mdpi.com/article/10.3390/curroncol28040265/s1, https://www.liver.ca/patients-caregivers/liver-diseases/fatty-liver-disease/, https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf, https://creativecommons.org/licenses/by/4.0/. PubMed Central 2014;8(2):219-23. congenital malformations and anatomical variants. Patient characteristics including sex, age at diagnosis, and Body Mass Index (BMI), as well as baseline comorbidities including type 2 diabetes mellitus, hyperlipidemia, and hypertension, were collected. The data are not publicly available due to patient privacy. 3) showed a wedge-shaped hypointense area, as seen on non-enhanced CT, and T2-weighted images (Fig. We recently experienced a case of liver metastasis from colon cancer which appeared as a wedge-shaped hyperdense area on non-enhanced CT (computed tomography). 4).MRI is very useful for making the diagnosis of focal hepatic steatosis, which appears isointense or hyperintense to liver on in-phase images and loses signal on out-of-phase images. Several studies on the prevalence of focal liver lesions are primarily concerned with just one individual type of lesion or they investigate the prevalence for a given pre-existing disease [11, 1921]. All authors have read and agreed to the published version of the manuscript. St. Michaels Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada, Medical Sciences Building, 1 Kings College Circle, University of Toronto, Toronto, ON M5S 1A8, Canada, Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada, Lunenfeld-Tanenbaum Research Institute, 600 University Ave, Toronto, ON M5G 1X5, Canada. reported a prevalence of 7.2% in a population of patients with colorectal carcinoma [17]. Sohn J, Siegelman E, Osiason A. However, while elevated levels of liver biochemical tests often correlate with a diagnosis of fatty liver, a high proportion of patients with NAFLD exhibit normal liver profiles, making these tests inappropriate diagnostic markers that may not have drastically impacted the findings presented in our study [. Alcoholic fatty liver may be accompanied by inflammation and necrosis (alcoholic hepatitis) and permanent damage in the form of cirrhosis. Unable to process the form. Here, we observed that there is a trend towards a higher rate of CAS development within one year of follow-up among stage IIIII CRC patients who received chemotherapy compared to the no treatment group. The prevalence of FNH was 0.2% (n=81). Based on the results of our study, it is necessary to conduct prospective studies that involve a larger cohort of patients, who are controlled for comorbidities that may confound the association between CRC, statin use and the incidence of steatosis. Terminology Unusual patterns of hepatic steatosis caused by the local effect of insulin revealed on chemical shift MR imaging. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin and adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. Current Oncology | Free Full-Text | Evaluation of Adjuvant Chemotherapy (2012) Prevalence of non-cardiac pathology on clinical transthoracic echocardiography. Vigano, L.; De Rosa, G.; Toso, C.; Andres, A.; Ferrero, A.; Roth, A.; Sperti, E.; Majno, P.; Rubbia-Brandt, L. Reversibility of chemotherapy-related liver injury. It is therefore difficult to compare the various study results and apply them to routine ultrasound primary diagnostics. These conclusions have critical implications on the quality of life and hepatic function of patients not only in the curative setting, but may also be applicable in the setting of treatment of metastatic disease, in particular in context of patients requiring liver resections for metastases in addition to indefinite metastatic treatment which may require up to 60 cycles of 5-FU-based chemotherapy. M.C.M.L. What does Focal fatty sparing is seen adjacent to the gallbladder fossa mean A 32-year-old male asked: Incidental observation of fatty liver with fatty sparing around the gallbladder fossa in ct trauma analysis? Visit our dedicated information section to learn more about MDPI. ; Van Hazel, G.; Wong, A.; Diaz-Rubio, E.; Gilberg, F.; Cassidy, J. Capecitabine versus 5-fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: Final results from the X-ACT trial with analysis by age and preliminary evidence of a pharmacodynamic marker of efficacy. The dynamic contrast enhancement techniques, CTA and dynamic MR imaging, showed irregular enhancement in the abnormal area, which indicated disappearance of the normal vessel structure and was quite useful for diagnosing the metastatic tumor. CAS Hepatic pseudolesion: appearance of focal low attenuation in the medial segment of the left lobe at CT arterial portography. Fatty liver deposition and sparing: a pictorial review 2. Although standard MR sequences are less helpful for visualization and characterization of fatty infiltration, chemical shift images (opposed- and in-phase images) are quite useful for depicting fat distribution and assist the diagnosis of focal fatty infiltration or sparing (7). Oxaliplatin, Fluorouracil, and Leucovorin as Adjuvant Treatment for Colon Cancer. On sonography, the entire liver showed increased echogenicity, suggestive of fat deposition. No specific therapy is available except to eliminate the cause or treat the underlying disorder. Introduction: Focal fatty sparing is a manifestation of fatty liver. The liver was examined in inter- and/or subcostal planes with a fan-like motion allowing assessment of both the hepatic parenchyma and the intrahepatic bile ducts. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-33796. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Areas of focal fatty sparing of the liver adjacent to the gallbladder and porta hepatis, absolute value of liver density less than 40 HU or a density difference greater than 25 HU between the spleen and liver on contrast-enhanced CT, increased echogenicity of the liver, attenuation of the ultrasound wave, loss of definition of the diaphragm, and poor delineation of the intrahepatic architecture on ultrasound and signal drop of liver parenchyma on the T1 weighted out of phase imaging on MRI was considered fatty liver [, A log binomial regression model was used to calculate adjusted relative risks. It is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. In our study, this figure fell almost linearly with increasing age and amounted to only 66.8% in the group of patients over 70years of age. Among various candidate drugs under investigation, statins have been considered as a potential therapeutic option, and were recently shown to effectively reduce the risk of NAFLD development in a large population-based study [, Colorectal cancer (CRC) consistently ranks as one of the leading causes of cancer-related deaths in Canada [. A total of 44.9% of these patients were outpatients and 55.1% inpatients. This study was also limited in that many potentially useful clinical and demographic data such as duration of statin administration and lifestyle factors contributory to steatosis could not be collected due to the retrospective nature of the investigation. Conclusion: Detection of focal fatty sparing is associated with an increased attenuation coefficient and is thus an expression of higher-grade hepatic fatty degeneration. As also found by Aubin et al., one possible cause could be the lower clustering of focal fatty sparing in patients with status post cholecystectomy, whose number increases with age and occurs more frequently in a hospital population than in a random sample of the entire population [24]. Epidemiology Fat accumulation is one of the most common abnormalities of the liver depicted on cross-sectional images. (c) Opposed-phase MR images show a hyperintense area in the entirely hypointense liver (TR = 120, TE = 2.1). Two further examinations were therefore performed to distinguish between these two types of lesion. diffuse hepatic steatosis. Ultrasound features only become apparent when the amount of fat reaches 15-20%. Eur J Radiol 83:930934, Marin D, Galluzzo A, Plessier A, et al. The finding of a FNH or an adenoma is rarely a fortuitous result. There are some case reports about this kind of tricks revealed by computed tomography (CT) and magnetic resonance imaging. Retrospective and prospective studies based on ultrasound have reported prevalence data for hepatic cysts of between 0.1% and 11.3% [7, 9, 23, 29]. The histological findings eventually revealed that the tumor, an adenocarcinoma, was surrounded by fibrotic tissue that mimicked focal sparing. Men were affected much more often (63.5%) than women (36.5%). The frequency of focal fatty sparing in patients with hepatic steatosis decreased with age and in the youngest age group of patients with hepatic steatosis, namely under 30years of age, the specific prevalence of focal fatty sparing was over 90%. methicillin-resistant Staphylococcus aureus, Oxford University Press is a department of the University of Oxford. An assessment of the safety and efficacy of statins in a randomized controlled cohort will allow for an accurate investigation into this phenomenon that contributes to a secondary health burden for the curative CRC patient population. Focal Fatty Infiltration of the Liver. 1); enhanced CT was not done. The CEA level was 15.1 ng/ml and the cancer antigen 199 (CA199) level 167.4 U/ml. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. ; Lee, H.S. Introduction. (2011) ISBN: 9781451118124. Effects of Statin Use on the Development and Progression of Nonalcoholic Fatty Liver Disease: A Nationwide Nested Case-Control Study. designed the study and conducted data collection. Most hepatic cysts were found in the oldest patients, with a frequency of 38.5% (n=1012). Check for errors and try again. The serum albumin level was 3.2 g/dl (normally 3.94.9 g/dl) and the cholinesterase level 108 IU/l (185430 IU/l). You seem to have javascript disabled. Detection of Hepatic Steatosis on Contrast-Enhanced CT Images Andr, T.; Boni, C.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Bonetti, A.; Clingan, P.; Bridgewater, J.; Rivera, F.; et al. Results with inadequate or incomprehensible written or visual documentation of the finding were excluded from the study. ; Jastreboff, A.M.; Nadolsky, K.; Pessah-Pollack, R.; Plodkowski, R. Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. Gut 32:677680, Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D (1993) Ecographic epidemiology of non-parasitic hepatic cysts. With our determined prevalence of 5.8%, we are also here in the mid-range. Patient consent was waived due to retrospective nature of the study. 1.1.11 Fatty liver and focal sparing | Ultrasound Cases 2021. Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. Focal fatty sparing of the liver is the localized absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. Liver areas with reduced focal, rarely zonal accumulation of fat can occur in hepatic steatosis. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). Other variables included clinical data pertaining to their cancer and variables that may influence steatosis development, such as tumour location, whether primary surgical resection was performed, pelvic radiation status, steroid use, statin use, alcohol consumption, and duration and type of adjuvant chemotherapy received. and Strunk et al. Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. Conclusions The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion. Current Oncology. Examinations were performed using following devices: Philips HDI 3000, HDI 5000, IU22, Toshiba Aplio 500, and Siemens Acuson S3000. The prevalence of hepatic hemangioma was 3.3% (n=1640), while that of FNH was 0.2% (n=81) and that of hepatic adenoma was 0.04% (n=19). 2 test for categorical variables, unless the sample size was too small, in which case Fishers exact test was used. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive acquired and interpreted radiology image data. Mittal, S.; El-Serag, H.B. Marked increase in echogenicity with poor penetration of p. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. This proved that the lesion was an adenocarcinoma and right hepatectomy was performed on July 4, 1996. It is therefore the method of choice in primary diagnostic investigations in most specialist areas of medicine, but especially for imaging the abdomen [1]. The highest prevalence was found in younger women, and 86.4% (n=70) of all patients with FNH were females. PubMed ; Hobbs, H.H. Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for Zentralbl Chir 123:119123, CAS Scand J Gastroenterol 50:355359, Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C (2013) Fortuitously discovered liver lesions. Radiology. Focal gallbladder wall thickening (differential) - Radiopaedia CT during arterial portography (CTAP) (Fig. In relation to the CT, MRI, and autopsy studies, our prevalence is in the mid to lower third of the range. Onaya et al. ; Kanwal, F.; Duan, Z.; Temple, S.; May, S.B. This study was approved by the St. Michaels Hospital Research Ethics Board (approval number: 18-166). Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Our figure of 0.18% is markedly lower than the data published to date. Such atypical cases may simulate neoplasms on CT scans (1,810). (b) CT during arterial portography clearly shows a wedge-shaped hypointese area in the anterior segment, indicating ischemia, due to intrahepatic portal vein blockade. Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. There appears to be some relationship between the high density around the gallbladder area and the fatty liver. The research group of Koseoglu reported a prevalence of focal fatty sparing of up to 19.8 [18] Strunk et al. Thus, in this study, we sought to describe the frequency of CAS in stage IIIII CRC patients and to determine the incidence of CAS in patients who were prevalent users of statins during their adjuvant chemotherapy. Search for other works by this author on: Department of Pathology, Gifu University School of Medicine, Focal spared areas in fatty liver caused by regional decreased portal flow, Nodular focal fatty infiltration of the liver: CT appearance, Multifocal fatty infiltration of the liver: report of six cases, A case of focal fatty liver difficult to distinguish from the liver metastasis of rectal cancer on CT, Focal sparing around the gallbladder in fatty liver: a useful sign for the diagnosis of borderline cases by CT, Focal manifestations of diffuse liver disease at MR imaging, Focal spared area in fatty liver simulaing a mass: Scintigraphic evaluation, Focal sparing in fatty infiltration of the liver, Computed tomographic and ultrasound appearances of focal spared areas in fatty infiltration of the liver, Liver metastases from ovarian cystadenocarcinoma masquarading on CT as lobar fatty infiltration, Metastatic tumors in irregular fatty liver mimicking focal sparing, Projection of the number of new cancer cases in the world, Cross-cultural comparison of continuous deep sedation for advanced cancer patients in East Asian countries: prospective cohort study, The efficacy and safety of trastuzumab deruxtecan (T-DXd) in HER2-expressing solid tumours: a single-arm meta-analysis, A new era of the Asian clinical research network: a report from the ATLAS international symposium, Factors affecting polyglycolic acid sheet engraftment success for covering mucosal defects from head and neck surgery, About Japanese Journal of Clinical Oncology, Receive exclusive offers and updates from Oxford Academic. Fatty Liver Disease. The gallbladder is a small, pear-shaped organ on the right side of the belly (abdomen), beneath the liver. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). 5. Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. ; Foley, W.D. permission is required to reuse all or part of the article published by MDPI, including figures and tables. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Editors select a small number of articles recently published in the journal that they believe will be particularly Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. Introduction. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. is fatty lever curable? Prevention of coronary heart diseases with pravastatin in men with hypercholesterolemia: West of Scotland coronary prevention study group. Inclusion criterion for this analysis was a positive sonographic diagnosis of benign focal liver lesions (hepatic cysts, hepatic hemangioma, FNH, hepatic adenoma and focal fatty sparing; Figs. Studies concerning the prevalence of benign focal liver lesions present a quite heterogeneous picture as regards the precise research question posed, the size of the population studied, and the investigative methods used. The size and age structure of the respective study populations, as well as the quality of the ultrasound equipment used, need to be considered here. Abdom Radiol 41, 2532 (2016). A characteristic location for focal hepatosteatosis is the medial segment of the left lobe of the liver (segment 4) either anterior to the porta hepatis or adjacent to the falciform ligament 1. The age-dependent frequency of hepatic steatosis and the related prevalence of focal fatty sparing in patients with hepatic steatosis were also determined (Table2). Mechanistic review of drug-induced steatohepatitis. Garvey, W.T. The second most commonly diagnosed liver lesion was the hepatic cyst, with 5.8% (n=2631). He had undergone sigmoidectomy for well differentiated adenocarcinoma of the sigmoid colon on September 2, 1993 in our department. We investigated the potential association between adjuvant chemotherapy and the development of steatosis among patients with stage IIIII CRC. Google Scholar, Buscarini E, Danesino C, Plauchu H, et al. Sigler, M.A. Please let us know what you think of our products and services. The serum bilirubin and ammonia levels had recovered almost to normal by about five weeks after the operation and the patient was discharged on the 74th postoperative day. This difference can be related to the population size and age of the patients studied [13, 14]. It is likely to have different pathogenesis than non-alcoholic steatohepatitis which is a diffuse process. Focal hepatic steatosis. In this study, Stage IIIII colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. 2). Postoperative liver insufficiency and sepsis were diagnosed and intensive care including plasma exchange and administration of vancomycin was performed. Srensen, P.; Edal, A.; Madsen, E.; Fenger, C.; Poulsen, M.R. Alpern, M.B. cholecystoses cholesterolosis adenomyomatosis masses gallbladder polyps gallbladder carcinoma: look for infiltration into adjacent organs, metastases, lymphadenopathy, bile duct dilatation leiomyosarcoma 1 metastases to the gallbladder: rare 1. Available online: Goldberg, D.; Ditah, I.C. Hepatic toxicity associated with fluorouracil plus levamisole adjuvant therapy. Fatty sparing - what is it? | Liver Problems | Forums | Patient Friedman, S.L. On the liver ultrasonography, the liver showed increased echogenicity suggestive of fatty liver grade 2. Lower prevalence was again determined in the highest age groups. ; Syrigos, K.N. For continuous variables, the mean and standard deviation were calculated, while categorical attributes were presented in absolute and relative frequencies. Our prevalence figure of 3.6% for hemangioma lies in the mid-range compared to the previously published results from ultrasound-based studies [6, 7, 9, 17]. Diagnosis of fatty liver disease: Is biopsy necessary? It may include one or more of the following: supervised medical detox behavioral therapies, such as cognitive behavioral therapy or. 84.2% (n=16) of patients with adenoma were women. Of the remaining 193 cases, patients receiving adjuvant chemotherapy (, Hepatic steatosis is characterized by the infiltration and accumulation of triglyceride within the liver parenchyma [, There is currently no approved pharmacologic treatment for hepatic steatosis, whether metabolic syndrome- or drug-induced. Through higher performance ultrasound equipment and the introduction of contrast-enhanced ultrasound, the diagnosis of FNH can nowadays be made with higher sensitivity and specificity [31].