Diffuse steatosis of the liver is a relatively rare condition. It is caused by an underlying vascular disease. This condition can overlap with focal liver disease and can lead to hepatocellular carcinoma or hepatic fibrosis. A diagnosis of diffuse steatosis of the liver requires a comprehensive assessment of the patient’s symptoms and physical examination.
Steatosis of the liver can be diagnosed by ultrasound. Ultrasound can detect fatty changes in the liver by measuring the echogenicity of liver parenchyma. However, the method has limitations in quantifying fatty changes. A new technique called controlled attenuation parameter (CAD) is available in conjunction with elastography. This technique can detect steatosis as high as 10%, though its utility is still being studied.
Patients with diffuse steatosis of the hepatic artery may have a fatty liver that makes it difficult to assess the liver’s appearance. Although steatosis is typically associated with focal fatty sparing, this type of steatosis can progress to cirrhosis and necroinflammatory changes. It can be caused by an imbalance in the delivery of fat to the liver and fat metabolism.
A CT-scan of the liver may also reveal focal fat in the liver. In rare cases, the liver may also have residual focal hepatic tissue that has not been affected by fatty deposition. The most reliable method to identify focal fat is MR imaging, particularly out-of-phase T1-weighted imaging, which emphasizes the presence of fat in water-containing tissues.