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Title: Incidental hepatic steatosis on unenhanced computed tomography performed for suspected renal colic: Gaps in reporting and documentation.
Austin Authors: Kutaiba, Numan ;Richmond, Danielle;Morey, Matthew;Brennan, Daniel;Rotella, Joe-Anthony ;Ardalan, Zaid S M;Goodwin, Mark D 
Affiliation: Gastroenterology Department, Alfred Health and Monash University, Melbourne, Victoria, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
The University of Melbourne, Melbourne, Victoria, Australia
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Aug-2019 2019-03-15
Publication information: Journal of Medical Imaging and Radiation Oncology 2019; 63(4): 431-438
Abstract: Hepatic steatosis is a common incidental finding on computed tomography (CT) in patients presenting to the emergency department (ED). The aims of our study were to assess the prevalence of hepatic steatosis in ED patients with suspected renal colic and to assess documentation in radiology reports and medical charts correlated with alanine transaminase (ALT) levels. Over 18 months from January 2016 to June 2017, all unenhanced CTs performed for suspected renal colic were reviewed. Quantitative assessment measuring hepatic and splenic attenuation in Hounsfield Units was performed. Hepatic steatosis was defined using multiple CT criteria including liver/spleen (L/S) ratio. Radiology reports, medical charts and ALT levels, if collected within 24 h of CT, were reviewed. A total of 1290 patients were included with a median age 52.5 years (range 16-98) and male predominance (835 [64.7%]). A total of 336 (26%) patients had hepatic steatosis measured by L/S ratio of ≤ 1.0. Ninety-four patients (28%) had radiology reports noting steatosis. Documentation in medical charts was noted in 18 of the 94 patients (19.1%) for whom steatosis was reported. Liver enzymes were available for 704 (54.6%) patients. There was a significantly higher mean ALT level in patients with hepatic steatosis (42.2 U/L; 95% CI 38.4-46.0) compared to patients without (28.8 U/L; 95% CI 25.7-31.9) (P < 0.0001). Our findings highlight multiple gaps in the reporting and evaluation of hepatic steatosis among radiologists and emergency clinicians alike. Recognising and reporting this incidental finding may impact health outcomes.
DOI: 10.1111/1754-9485.12873
ORCID: 0000-0003-4627-9847
PubMed URL: 30874372
Type: Journal Article
Subjects: alanine transaminase
computed tomography
fatty liver
incidental findings
non-alcoholic fatty liver disease
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