Kutaiba Numan, Richmond Danielle, Morey Matthew, Brennan Daniel, Rotella Joe-Anthony, Ardalan Zaid, Goodwin Mark
Radiology Department, Austin Health, Melbourne, Victoria, Australia.
Emergency Department, Austin Health, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2019 Aug;63(4):431-438. doi: 10.1111/1754-9485.12873. Epub 2019 Mar 15.
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.
肝脂肪变性是急诊科（ED）患者计算机断层扫描（CT）中常见的偶然发现。我们研究的目的是评估疑似肾绞痛的ED患者中肝脂肪变性的患病率，并评估放射学报告和与丙氨酸转氨酶（ALT）水平相关的病历记录情况。
回顾2016年1月至2017年6月18个月期间，所有因疑似肾绞痛进行的非增强CT扫描。采用亨氏单位对肝脏和脾脏衰减进行定量评估。使用包括肝/脾（L/S）比值在内的多种CT标准定义肝脂肪变性。对放射学报告、病历记录以及CT扫描后24小时内采集的ALT水平进行回顾。
共纳入1290例患者，中位年龄52.5岁（范围16 - 98岁），男性占优势（835例[64.7%]）。共有336例（26%）患者通过L/S比值≤1.0测量出肝脂肪变性。94例（28%）患者的放射学报告提及了脂肪变性。在报告有脂肪变性的94例患者中，18例（19.1%）的病历记录中有相关记载。704例（54.6%）患者有肝酶数据。与无肝脂肪变性的患者相比，有肝脂肪变性的患者平均ALT水平显著更高（42.2 U/L；95% CI 38.4 - 46.0），无肝脂肪变性的患者为28.8 U/L（95% CI 25.7 - 31.9）（P < 0.0001）。
我们的研究结果凸显了放射科医生和急诊临床医生在肝脂肪变性报告和评估方面存在的多个差距。认识并报告这一偶然发现可能会影响健康结局。
