CT can provide faster, easier-to-capture evidence of non-alcoholic fatty liver disease than MRI or ultrasound elastography.
Non-alcoholic fatty liver disease (NAFLD) is rapidly becoming the most common cause of liver disease worldwide, and multi-parametric CT can be an effective way for providers to identify which patients have the condition.
With NAFLD affecting roughly 25 percent of adults across the globe – and nearly a quarter of those individuals progressing on to non-alcoholic steatohepatitis (NASH), a precursor to cirrhosis – finding a strategy that can pinpoint patients who could benefit from treatment is critical.
In an article published Jan. 22 in the American College of Roentgenology, a team of investigators from the University of Wisconsin outlined the CT parameters that enable non-invasive NAFLD detection. They also presented their results during the American Roentgen Ray Society (ARRS) 2019 annual meeting.
Related Content: MRI Technique Can Estimate Liver Fat in Children
“CT is a highly accessible, frequently used method for assessment of patients with NAFLD and identification of those with high-risk NAFLD (advanced fibrosis or cirrhosis) who are potentially most in need of intervention,” said the team led by Meghan G. Lubner, M.D., professor of radiology in the abdominal imaging section at Wisconsin.
True-positive assessments in 58-year-old woman with high-risk nonalcoholic fatty liver disease (NAFLD) and associated NASH. CT images show hepatic enlargement, heterogeneously low-attenuation hepatic parenchyma, and surrounding ascites. Readers correctly identified NASH according to these imaging features. Readers also correctly identified fibrosis stage F3. Courtesy: American Journal of Roentgenology
True-positive assessments in 52-year-old man with high-risk nonalcoholic fatty liver disease (NAFLD) and associated NASH. CT images show hepatic enlargement, heterogeneously low-attenuation hepatic parenchyma, and surrounding ascites. Readers correctly identified NASH according to these imaging features. Readers also correctly identified fibrosis stage F3. Courtesy: American Journal of Roentgenology
The use of multi-parametric CT fills a void, the team said. Both MR and ultrasound elastography techniques has been successful in measuring liver stiffness as a surrogate for fibrosis. But, they come with obstacles – not only do they require a significant level of expertise, but they also are not used much in the clinical setting. In contrast, non-invasive CT biomarkers are frequently used clinically to diagnose liver disease and hepatic fibrosis.
For this study, Lubner’s team focused specifically on identifying patients with high-risk NAFLD. In a single-institution retrospective cohort study, they looked at CT images captured on 16-to-64-MDCT scanners within a year of liver biopsy from 186 patients with the condition. Most images were contrast-enhanced.
False-positive assessments in 73-year-old woman with high-risk NAFLD but without pathologic evidence of NASH. CT images show findings similar to A and B. Readers incorrectly identified NASH because of these imaging findings but correctly identified fibrosis stages F3. Courtesy: American Journal of Roentgenology
False-positive assessments in 61-year-old woman with high-risk NAFLD but without pathologic evidence of NASH. CT images show findings similar to A and B. Readers incorrectly identified NASH because of these imaging findings but correctly identified fibrosis stages F4. Courtesy: American Journal of Roentgenology
Of the group, 87 individuals had NASH, and 112 had moderate-to-severe steatosis. For fibrosis stages, 51 were F0, 42 were F1, 23 were F2, 37 were F3, and 33 were F4. A group of 70 individuals – 38 percent – had advanced fibrosis and high-risk NAFLD.
Based on the team’s analysis, the Fibrosis-4 (FIB-4) index score correlated with fibrosis with ROC AUC of 0.75 for identifying high-risk NAFLD. In addition, the CT parameters liver segmental volume ratio and splenic volume performed best – they both had an AUC of 0.69 for detection of the condition.
“Patients with a high FIB-4 score and CT findings of advanced fibrosis may no longer need biopsy for confirmation,” the team said. “Therefore, use of FIB-4 and CT together may reduce the need for invasive testing.”
Overall, however, they explained, reader assessment – a subjective cognitive combination of the measured features by trained readers – was the highest performing parameter with an AUC of 0.78 and 0.79 for both readers. Performance by the readers revealed a good association with the presence of advanced fibrosis.
While CT performed well for NAFLD detection, it was underwhelming for picking up on evidence of NASH. According to the team, all single imaging parameters, including subjective reader assessment, performed poorly.
For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter here.
Stay at the forefront of radiology with the Diagnostic Imaging newsletter, delivering the latest news, clinical insights, and imaging advancements for today’s radiologists.
The Reading Room Podcast: A Closer Look at Remote MRI Safety, Part 2
July 25th 2025In the second of a multi-part podcast episode, Emanuel Kanal, M.D. and Tobias Gilk, MRSO, MRSE, share their perspectives on remote MRI safety protocols for ensuring screening accuracy and adherence to conditional implant guidelines as well as a rapid and effective response to adverse events.
The Reading Room Podcast: Current and Emerging Insights on Abbreviated Breast MRI, Part 2
July 23rd 2025In the second part of a multi-part podcast episode, Stamatia Destounis, MD, Emily Conant, MD and Habib Rahbar, MD, discuss key sequences for abbreviated breast MRI and how it stacks up to other breast cancer screening modalities.
Study Reveals Significant Prevalence of Abnormal PET/MRI and Dual-Energy CT Findings with Long Covid
July 22nd 2025In a prospective study involving nearly 100 patients with Long Covid, 57 percent of patients had PET/MRI abnormalities and 90 percent of the cohort had abnormalities on dual-energy CT scans.