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Suggest Tests To Diagnose Fatty Liver
Question: Sir/Mam, I would like to know which is the best method to diagonise fatty liver. I have Sonography where it was mentioned liver is normal in size with grade 1 fatty chnage. But on CT scan it is normal study not mentioned about fatty liver (just mildy enlarged liver) the CT scan was performed 2 months ago but the sonography was recent. It is now 4 months I am taking medicine my SGOT & SGPT are normal.
Brief Answer:
Ultrasound mild fatty liver is not a concern if blood tests are normal.
Detailed Answer:
Hi XXXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Everyday I do reporting of ultrasound scan and CT scan in many patient and have come across people with query similar to what you have.
In ultrasound scan, the diagnosis of fatty liver is very subjective and usually based on the appearance of liver and the and its comparison as per criteria laid down by imaging guidelines. In my experience, fatty liver is diagnosed in many patients based on the subjective appearance (what the person doing the ultrasound feels). This is an individual opinion and might differ with different radiologists. Some may give normal while some can call it grade I fatty liver on ultrasound scan due to technical factors affecting image formation. Based on this method, there is a possibility of grade I fatty liver being given on ultrasound scan but this does not fulfill the CT scan criteria which is purely technical.
Under above circumstances, if your SGOT and SGPT are normal then there is no need to worry about liver. You may do lipid profile tests to know any high cholesterol if required.
A mildly fatty liver on ultrasound is very common made diagnosis and not a concern. If you take alcohol regularly then it is advisable to control your drinking habits. If you consume lots of fatty foods then it is better to check your cholesterol numbers.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Ultrasound mild fatty liver is not a concern if blood tests are normal.
Detailed Answer:
Hi XXXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Everyday I do reporting of ultrasound scan and CT scan in many patient and have come across people with query similar to what you have.
In ultrasound scan, the diagnosis of fatty liver is very subjective and usually based on the appearance of liver and the and its comparison as per criteria laid down by imaging guidelines. In my experience, fatty liver is diagnosed in many patients based on the subjective appearance (what the person doing the ultrasound feels). This is an individual opinion and might differ with different radiologists. Some may give normal while some can call it grade I fatty liver on ultrasound scan due to technical factors affecting image formation. Based on this method, there is a possibility of grade I fatty liver being given on ultrasound scan but this does not fulfill the CT scan criteria which is purely technical.
Under above circumstances, if your SGOT and SGPT are normal then there is no need to worry about liver. You may do lipid profile tests to know any high cholesterol if required.
A mildly fatty liver on ultrasound is very common made diagnosis and not a concern. If you take alcohol regularly then it is advisable to control your drinking habits. If you consume lots of fatty foods then it is better to check your cholesterol numbers.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for your reply. But I did not understand whether CT scan is more reliable. I have lipid profile test, cholestrol is normal only TG is 225. Also I would like to mention I have a sonography 3 months later where it was mentioned Grade I fatty liver with mild hepatomegaly. And recent sonography where it was mentioned that Liver is normal in size with Grade 1 fatty change. Whether medication is required for finding normal ecotexture.
Brief Answer:
CT calculations can confirm fatty liver.
Detailed Answer:
Hi XXXXXXX,
Thanks for writing back with an update.
Your concern about reliability of CT scan is understandable.
The CT scan uses computer mathematical calculations and fatty liver can be said by the following methods.
(i) low hepatic density compared to spleen during pre-contrast and portal venous phase imaging
non-fatty liver is normally 6-12HU greater density than spleen
arterial phase or very early portal venous phase scans should not be used as the spleen enhances earlier than the liver due to predominant systemic arterial supply. Fatty liver can be diagnosed at contrast-enhanced CT if absolute attenuation is less than 40 HU, but this threshold has limited sensitivity
(ii) relatively hyperdense appearing intrahepatic vessels
As CT scan is based on calculations, diagnosis of fatty liver made by above methods is reliable.
Ultrasound is by looking at images and not as reliable and therefore it is best to go by CT scan if proper methods are used.
Triglycerides need to be discussed with your doctor and treated with medications with diet control.
There is no medication for normal liver echotexture.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
CT calculations can confirm fatty liver.
Detailed Answer:
Hi XXXXXXX,
Thanks for writing back with an update.
Your concern about reliability of CT scan is understandable.
The CT scan uses computer mathematical calculations and fatty liver can be said by the following methods.
(i) low hepatic density compared to spleen during pre-contrast and portal venous phase imaging
non-fatty liver is normally 6-12HU greater density than spleen
arterial phase or very early portal venous phase scans should not be used as the spleen enhances earlier than the liver due to predominant systemic arterial supply. Fatty liver can be diagnosed at contrast-enhanced CT if absolute attenuation is less than 40 HU, but this threshold has limited sensitivity
(ii) relatively hyperdense appearing intrahepatic vessels
As CT scan is based on calculations, diagnosis of fatty liver made by above methods is reliable.
Ultrasound is by looking at images and not as reliable and therefore it is best to go by CT scan if proper methods are used.
Triglycerides need to be discussed with your doctor and treated with medications with diet control.
There is no medication for normal liver echotexture.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Prasad
Sir, thank u for your reply. Sir, what you have mentioned is somewhat understandable to me, becoz those were techical term. Anyway should I consider my findings as normal. At present I am taking Heptral 400 and medicine containing ( silymarin & lecithin). Should I continue the treatment. Can I take alcohol twice or thrice a month.
Brief Answer:
Your findings are more towards normal.
Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.
Your findings are more towards normal. You can continue taking the medications Heptral 400 and silymarin lecithin in prescribed doses. However if your liver enzymes SGOT and SGPT are normal then you can stop taking these after discussing with your doctor.
Taking alcohol 2 to 3 times a month is acceptable. Please avoid taking too oily foods everyday.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Your findings are more towards normal.
Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.
Your findings are more towards normal. You can continue taking the medications Heptral 400 and silymarin lecithin in prescribed doses. However if your liver enzymes SGOT and SGPT are normal then you can stop taking these after discussing with your doctor.
Taking alcohol 2 to 3 times a month is acceptable. Please avoid taking too oily foods everyday.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
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Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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