Department of Internal Medicine at The Massachusetts General Hospital, Boston, MA, USA,
Dig Dis Sci. 2015 Feb;60(2):333-8. doi: 10.1007/s10620-014-3346-5. Epub 2014 Sep 5.
Nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease, is frequently diagnosed incidentally on imaging. The goal of the present study was to characterize rates of documentation and evaluation of incidentally identified steatosis.
Adults who underwent abdominal computed tomography with incidentally reported steatosis from January 2008 to October 2011 and with ≥1 primary care appointment within 14 months following imaging were included.
One hundred twenty-seven individuals with newly identified steatosis on imaging were included. Medical record documentation of newly identified steatosis occurred in only 29 individuals (22.8 %). Mention of steatosis within the "impression" section of radiology reports in addition to the report body was associated with significantly higher likelihood of primary care documentation (p = 0.007). Primary care documentation of steatosis was associated higher rates of evaluation for the etiology of steatosis include testing of aminotransferase levels (96.5 vs. 77.5 %, p = 0.025), alcohol use screening (89.6 vs. 66.3 %, p = 0.02), and hepatitis C screening (20.6 vs. 2.0 %, p = 0.002). No patient had documentation of the NAFLD fibrosis score and none were referred for specialist evaluation or for liver biopsy. However, when calculated, the NAFLD fibrosis score identified 14 patients (11 %) as high risk for advanced hepatic fibrosis.
Documentation of incidentally identified steatosis is infrequent but was improved when steatosis was mentioned in the "impression" of radiographic reports. Documentation of steatosis was associated with increased rates of aminotransferase testing and alcohol use and hepatitis C screening. An important proportion of individuals with incidentally identified steatosis are at high risk of fibrosis and may benefit from additional evaluation.
非酒精性脂肪性肝病（NAFLD）是最常见的肝病病因，常通过影像学检查偶然诊断。本研究旨在描述偶然发现的脂肪变性的记录和评估率。
纳入 2008 年 1 月至 2011 年 10 月期间行腹部计算机断层扫描（CT）且报告有偶然发现的脂肪变性，并在影像学检查后 14 个月内有≥1 次初级保健就诊的成年人。
127 名影像学检查新发现脂肪变性的患者纳入本研究。仅有 29 名（22.8%）患者的病历中记录了新发现的脂肪变性。在放射学报告的“印象”部分中提及脂肪变性且报告主体中也提及脂肪变性与初级保健记录的可能性显著增加相关（p=0.007）。初级保健记录脂肪变性与更频繁地评估脂肪变性病因相关，包括检测转氨酶水平（96.5%比 77.5%，p=0.025）、酒精使用筛查（89.6%比 66.3%，p=0.02）和丙型肝炎筛查（20.6%比 2.0%，p=0.002）。没有患者记录 NAFLD 纤维化评分，也没有患者被转诊给专家评估或进行肝活检。然而，当计算 NAFLD 纤维化评分时，14 名患者（11%）被确定为晚期肝纤维化的高危患者。
偶然发现的脂肪变性的记录频率较低，但当脂肪变性在放射学报告的“印象”中提及时，记录频率会增加。脂肪变性的记录与转氨酶检测、酒精使用和丙型肝炎筛查的频率增加相关。偶然发现的脂肪变性的很大一部分患者存在肝纤维化的高风险，可能需要进一步评估。
