Urinary Tract and male reproductive system Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. For more information, please refer to There was also a hypoechoic mass in segment 6 of the liver measuring, 4.8 3.1 cm. Google Scholar, Ruiz Guinaldo A, Martn Herrera L, Roldn Cuadra R (1997) Hepatic tumors in patients with cirrhosis: an autopsy study. Color and power Doppler sonography were performed in 80 patients with a fatty liver that appeared as a fine echogenic pattern with considerable deep attenuation on sonography. ; Foley, W.D. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas (1). Kratzer et al. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). At the time the article was last revised Raymond Chieng had Fan, R.; Wang, J.; Du, J. The mean age was 64.7years. 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. The most common lesion was focal fatty sparing, which was diagnosed in 2839 cases, corresponding to a prevalence of 6.3%. 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. A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). 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. CT during arterial portography (CTAP) (Fig. (b) CT during arterial portography clearly shows a wedge-shaped hypointese area in the anterior segment, indicating ischemia, due to intrahepatic portal vein blockade. Sonography shows an elliptical mass surrounded by a halo, indicated by the white wedges, in the anterior segment of the right lobe; its internal echogenicity is irregular. Association between body mass index and fatty liver risk: A dose-response analysis. Moertel, C.; Fleming, T.; Macdonald, J.; Haller, D.G. We use cookies on our website to ensure you get the best experience. The finding of a FNH or an adenoma is rarely a fortuitous result. Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. Furthermore, there is currently a lack of medical treatment for any population affected by steatosis, regardless of etiology, although a recently published population-based study suggests that statins may confer protective benefits against the development of steatosis. Prevalence of hepatic steatosis in an urban population in the United States: Impact of ethnicity. A full blood count on admission showed normal values. In general, the treatment of the underlying condition will reverse the findings. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. It was suggested that the tumor caused this ischemia due to intrahepatic portal vein blockade. Radiology. In line with our results, all studies reported a higher prevalence of hepatic cysts with increasing age [19, 22, 23, 30]. https://doi.org/10.3390/curroncol28040265, Lee MCM, Kachura JJ, Vlachou PA, Dzulynsky R, Di Tomaso A, Samawi H, Baxter N, Brezden-Masley C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. Ultrasound results typical of adenomas and FNH were only included in the evaluation, if these had been confirmed by further imaging or histology. Detection of hepatic steatosis on contrast-enhanced CT images: Diagnostic accuracy of identification of areas of presumed focal fatty sparing. Focal sparing in diffusely fatty liver is a well recognized entity. Diagnosis of fatty liver with MR imaging. All authors have read and agreed to the published version of the manuscript. reported a higher prevalence of hepatic hemangioma in womenresulting that we were unable to corroborate with our data (Table3) [21, 29]. It was suggested that this fibrotic liver tissue corresponded to the area of focal sparing seen on CT and MR images. While liver enzymes play a central role in the three-step enzymatic cascade of capecitabine activation to its active metabolite, hepatotoxicity is considered a relatively rare side effect of capecitabine due to its selective activation within the tumor tissue [, Considering the low survival rates of CRC patients in the absence of treatment, adverse effects of CRC chemotherapy have been regarded as inevitable consequences of a necessary life-saving measure. Considerably more studies have investigated the prevalence of hepatic hemangioma than of focal fatty sparing, FNH, and adenoma [6, 7, 9, 11, 21]. Volume 33, Issue 8 August 2014 Pages 1447-1452 Information Download PDF Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. (2001) Frequency of benign hepatic lesions incidentally detected with contrast-enhanced thin-section portal venous phase spiral CT. Acta Radiol 42:172520, Lam KY (2002) Autopsy findings in diabetic patients: a 27year clinicopathologic study with emphasi on opportunistic infections and cancers. (d) In-phase MR images show a hypointense area in the entirely hyperintense liver (TR = 120, TE = 4.2). The level of significance was set at =5%, and the p value was given to four decimal places. https://doi.org/10.3390/curroncol28040265, Lee, Michelle C. M., Jacob J. Kachura, Paraskevi A. Vlachou, Raissa Dzulynsky, Amy Di Tomaso, Haider Samawi, Nancy Baxter, and Christine Brezden-Masley. MRI exhibits the highest sensitivity for detecting hepatic lipid infiltration and can detect as little as 5% steatosis in the liver at a sensitivity of 76.790.0% and a specificity of 87.191% [, Another limitation of this study is the relatively small sample size, particularly for the cohort of patients receiving statins. The investigating physician is therefore increasingly faced with the problem of differentiating between malignant and benign space-occupying processes and of distinguishing the various lesions from each other [24]. ; Saeian, K.; Lalehzari, M.; Aronsohn, A.; Gorospe, E.C. Browning, J.D. Gut Liver. We present the radiological features of this case and discuss how to arrive at a correct diagnosis. Essentially the same as those that contribute to diffuse hepatic steatosis 1,5: drugs (amiodarone, methotrexate, chemotherapy). Current Oncology. Ultrasound Med Biol 30:10891097, Soyer P, Bluemke DA, Van BB, Barge J, Levesque M (1993) CT of hepatic tumors: prevalence of the and specificity of retraction adjacent liver capsule. ; Gasbarrini, A.; Gasbarrini, G. Fatty liver and drugs. M.C.M.L. 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. Radiology Review Manual. is fatty lever curable? 2. Simple hepatic cysts and hemangiomas are the most common focal liver lesions. The finding of a FNH or an adenoma is rarely a random discovery. Variables found to be associated with both the exposure and outcome and thus, probably confounders, were selected as covariates based on a review of relevant literature. Focal gallbladder wall thickening is an imaging finding that includes both benign and malignant etiologies. Kaltenbach, T.EM., Engler, P., Kratzer, W. et al. https://www.mdpi.com/openaccess. Our figure of 0.18% is markedly lower than the data published to date. The used probes are C2-5, C1-5, and C1-6 (16MHz). Prevention of coronary heart diseases with pravastatin in men with hypercholesterolemia: West of Scotland coronary prevention study group. Focal fat deposition and focal fatty sparing. At the time the article was created Matt A. Morgan had no recorded disclosures. The project received a positive opinion from the local ethics committee (No. With only 19 cases and hence a prevalence of 0.04%, hepatic adenoma was the rarest of the liver lesions we investigated. 5. P.A.V. The prevalence of FNH was 0.2% (n=81). This study sought to examine hepatic steatosis, an increasingly recognized health concern worldwide. To date, only a few studies have been published on the prevalence of focal fatty sparing or of focal fat distribution disorders in the liver [8, 27]. In the absence of studies exploring the role of statin therapy in chemotherapy-associated steatosis (CAS), we speculated that the protective benefit of statins in fatty liver at large may translate to prevention of CAS among patients who are receiving statins at the time of their chemotherapy. Hepatocellular carcinoma in the absence of cirrhosis in united states veterans is associated with nonalcoholic fatty liver disease. Check for errors and try again. In the past 10years, comparatively few ultrasound-based studies have appeared on this subject [69]. permission is required to reuse all or part of the article published by MDPI, including figures and tables. 5). Semin Liver Dis 33:236247, Article CAS Find support for a specific problem in the support section of our website. CTAP showed a wedge-shaped ischemic area. R.D., A.D.T., H.S., N.B. In patients with an intact gallbladder, segments 4 and 5 were spared most often. Andr, T.; Boni, C.; Mounedji-Boudiaf, L.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Zaninelli, M.; Clingan, P.; Bridgewater, J.; et al. ; Petersen, O.F. Gandolfi et al. 1991;181 (3): 809-12. 2021; 28(4):3030-3040. Lee, J.I. The second most commonly diagnosed liver lesion was the hepatic cyst, with 5.8% (n=2631). The prevalence of FNH lies between 0.8% and 3.2% [1215], of hepatic adenoma from 0.4% to 1.5% [11, 12, 15, 16], and of focal fatty sparing between 7.2% and 19.8% [8, 17, 18]. ; Dzulynsky, R.; Di Tomaso, A.; Samawi, H.; Baxter, N.; Brezden-Masley, C. Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer. most exciting work published in the various research areas of the journal. 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). Chin, S.N. Despite its frequent association with liver injury, oxaliplatin is classically known to damage the liver via sinusoidal dilation and is thought to have a limited role in inducing steatohepatitis [, Since the FDA approval of capecitabine in 2001 as a chemotherapeutic agent, the oral route of 5-FU delivery became a mainstay of colorectal cancer treatment, alongside intravenous infusion. This difference can be related to the population size and age of the patients studied [13, 14]. Google Scholar, Sanfelippo P, Beahrs O, Weiland L (1974) Cystic disease of the liver. A total of 44.9% of these patients were outpatients and 55.1% inpatients. An evidence-based review of statin use in patients with nonalcoholic fatty liver disease. Features include: inability to visualise the portal vein walls (as the parenchyma is as bright as the wall), decreases by 1.6 HU per mg of fat in each gram of liver, liver and spleen should normally be similar on delayed (70 seconds) scans, earlier scans are unreliable as the spleen enhances earlier than the liver (systemic supply rather than portal), MRI is the imaging modality of choice in any case where the diagnosis is felt to be less than certain. described a higher prevalence of hemangioma in middle aged or older patients, while Rungsinaporn et al. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Jones J, Haouimi A, et al. Moreover, his temperature rose to 39 C on the 5th postoperative day, and methicillin-resistant Staphylococcus aureus (MRSA) was detected in his blood. Abbreviations: BMI, Body Mass Index; FOLFOX, oxaliplatin, fluorouracil, and folinic acid; XELODA, capecitabine; FUFA, fluorouracil and folinic acid. Gut 32:677680, Caremani M, Vincenti A, Benci A, Sassoli S, Tacconi D (1993) Ecographic epidemiology of non-parasitic hepatic cysts. ; Tomlinson, J.W. Hepatic pseudolesion: appearance of focal low attenuation in the medial segment of the left lobe at CT arterial portography. J Clin Pathol 39:183188, Article acquired and interpreted radiology image data. Google Scholar, Kreft B, Pauleit D, Bachmann R, et al. Sigler, M.A. Mostbeck GH (1996) Ultrasound screening examination of the abdomen: of value or senseless? 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. Overall, more adenomas were diagnosed in the younger patient groups under 50years of age than in the older ones. In this study, Stage II-III 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. Lu, Y.; Lin, Y.; Huang, X.; Wu, S.; Wei, J.; Yang, C. Oxaliplatin aggravates hepatic oxidative stress, inflammation and fibrosis in a non-alcoholic fatty liver disease mouse model. permission provided that the original article is clearly cited. (a) CT arteriogrphy discloses irregular enhancement in the anterior segment, as seen on dynamic MR imaging. 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. ; Mechanick, J.I. Ultrasound Q 23:7980, Kester NL, Elmore SG (1995) Focal hypoechoic regions in the liver at the porta hepatis: prevalence in ambulatory patients. Andr, T.; Boni, C.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Bonetti, A.; Clingan, P.; Bridgewater, J.; Rivera, F.; et al. MDPI and/or Men were affected much more often (63.5%) than women (36.5%). 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? 57% of all liver lesions found by ultrasound are benign [5]. Introduction: Focal fatty sparing is a manifestation of fatty liver. 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. Our measured mean cyst size of 2.2cm corresponds to the values published in the literature [19, 22, 23, 30]. Liver areas with reduced focal, rarely zonal accumulation of fat can occur in hepatic steatosis. FFL may result from altered venous flow to liver, tissue hypoxia and malabsorption of lipoproteins. J Clin Ultrasound 21:115118, Gaines PA, Sampson MA (1989) The prevalence and characterization of simple hepatic cysts by ultrasound examination. 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. At the time the article was last revised Jeremy Jones had no recorded disclosures. Kammen B, Pacharn P, Thoeni R et al. (2004) High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia. 2014;8(2):219-23. congenital malformations and anatomical variants. Most studies have also found a gender-dependent aspect, with higher prevalence figures for hepatic cysts in women [22, 23, 29, 30]. 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. 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. ; 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. 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. ; Syrigos, K.N. ; Gupta, R.K. The prevalence data published so far on hepatic adenoma are between 0.4% and 1.7%. These findings imply that if differentiation between focal fatty sparing and a tumor is undetermined and follow-up is performed, should any change occur, then an abnormality that is no longer appreciable at follow-up is probably focal fatty sparing rather than a true tumor. In our study cohort, we did not observe a significant difference in the risk of developing steatosis when comparing patients receiving oxaliplatin-containing chemotherapy compared to those on a 5-FU based regimen (RR 0.64, 95% CI 0.30 to 1.38) after adjusting for sex, BMI, type 2 diabetes mellitus, hyperlipidemia, and steroid use (, The demographics of 135 patients who were treated with chemotherapy were summarized based on statin administration status, shown in, Among patients who were on statins at the time of their adjuvant chemotherapy, 11 of 37 (29.7%) patients developed steatosis within one year; however, 41 of 98 (41.8%) patients who did not receive statin treatment developed steatosis. You are accessing a machine-readable page. He had undergone sigmoidectomy for well differentiated adenocarcinoma of the sigmoid colon on September 2, 1993 in our department. Miwa, M.; Ura, M.; Nishida, M.; Sawada, N.; Ishikawa, T.; Mori, K.; Shimma, N.; Umeda, I.; Ishitsuka, H. Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. and C.B.-M. contributed to the conception and design of the study. Recently, some reports have mentioned the appearance of a focal sparing area in the generalized fatty liver. Katsiki, N.; Mikhailidis, D.; Mantzoros, C. Non-alcoholic fatty liver disease and dyslipidemia: An update. Kim B, Oh J, Nam K et al. 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. The gallbladder is a small, pear-shaped organ on the right side of the belly (abdomen), beneath the liver. CAS was determined through a review of radiology reports, and images were reviewed by a single radiologist to maximize inter-rater reliability. PubMed Central Twelves, C.; Scheithauer, W.; McKendrick, J.; Seitz, J.F. Obika, M.; Noguchi, H. Diagnosis and evaluation of nonalcoholic fatty liver disease. (c) Opposed-phase MR images show a hyperintense area in the entirely hypointense liver (TR = 120, TE = 2.1). Haas, J.T. 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). 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. Scand J Gastroenterol 50:355359, Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C (2013) Fortuitously discovered liver lesions. The prevalence figures of the two ultrasound-based studies for FNH were 0.8% and 1.8% and lie below the figures of between 1.8% and 3.2% reported from CT, MRI, or pathological investigations [1215]. Other data that may have further enriched our findings include trending of lipid profiles as well as liver biochemical and function tests. No special Chalasani, N.; Younossi, Z.; Lavine, J.; Diehl, A.M.; Brunt, E.M.; Cusi, K.; Charlton, M.; Sanyal, A.J. The number of recent ultrasound studies on the prevalence of benign liver lesions is relatively limited. Two further examinations were therefore performed to distinguish between these two types of lesion. ; Compton, C.C. 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. Eur Radiol 21:20742082, Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. The mean age of patients at the time of the investigation was 5618.1years (range: 4months105years). (2001) Incidence and significance of small focal liver lesions in MRI. In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean SD, 35.9 1.14 months). Furthermore, there are only a few prevalence studies based on CT, MRI investigations, and autopsy studies [11, 12, 15, 16]. Ballestri, S.; Nascimbeni, F.; Baldelli, E.; Marrazzo, A.; Romagnoli, D.; Lonardo, A. NAFLD as a Sexual Dimorphic Disease: Role of Gender and Reproductive Status in the Development and Progression of Nonalcoholic Fatty Liver Disease and Inherent Cardiovascular Risk. ; Oliva, I.B. At further existing unclarity, an MRI was performed in unclear findings at MRI puncture of the lesions were attempted. 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). Medical oncologists at St. Michaels Hospital in Toronto, Canada, anecdotally observed that CRC patients receiving adjuvant chemotherapy appeared to develop fatty liver at a higher rate than expected when seen in follow-up, based on imaging. On MR imaging, T1-weighted images (Fig. Alcoholic fatty liver may be accompanied by inflammation and necrosis (alcoholic hepatitis) and permanent damage in the form of cirrhosis. 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. The treatment for ALD focuses on treating alcohol use disorder. Therefore, a fundamental knowledge of the prevalence and image morphology of hepatic hemangiomas, hepatic cysts, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing is essential. 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]. Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive 3). ; Lee, K.S. 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. 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. The age-dependent frequency of hepatic steatosis and the related prevalence of focal fatty sparing in patients with hepatic steatosis were also determined (Table2). CAS Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. The role of statins in the management of nonalcoholic fatty liver disease. Curr Gastroenterol Rep 17:12, Barthelmes L, Tait IS (2005) Liver cell adenoma and liver cell adenomatosis. Patients with polycystic liver diseases were excluded from this study. 84.2% (n=16) of patients with adenoma were women. Used criteria for the diagnosis of the lesions are presented in Table1. ; Rinella, M.; Sanyal, A.J. It is a spectrum of disease, ranging from hepatic fat accumulation without inflammation to steatohepatitis, fibrosis, cirrhosis, and end-stage liver disease. In addition, many studies on the prevalence of benign space-occupying lesions of the liver were conducted in the 1990s or earlier, i.e., at a time when the image quality of the ultrasound devices used was greatly inferior [17, 2123]. ; Kim, T.K. In terms of the abnormal finding in the anterior segment, non-enhanced CT suggested focal sparing and sonography suggested a metastatic tumor. 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. The term 'fatty infiltration of the liver' is often erroneously used to describe liver steatosis. (1991) Natural history of hepatic haemangiomas: clinical and ultrasound study. The majority of the more recent ultrasound-based prevalence studies show significantly higher prevalence figures than older ultrasound-based studies (Table4). ; Hazlehurst, J.M. The peak age for FNH occurred in the youngest patient group with 34.6% (n=28) of the diagnosed lesions and fell continuously with increasing age. ; Hobbs, H.H. Since drug-induced hepatotoxicity was described by Grieco et al. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas ().This condition, called focal sparing, can occur in . Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. The authors declare no conflict of interest. ; Arevalos, E.; Rimm, A.A. Focal hepatic masses and fatty infiltration detected by enhanced dynamic CT. Rofsky, N.M.; Fleishaker, H. CT and MRI of diffuse liver disease. Feature papers represent the most advanced research with significant potential for high impact in the field.