From the Guidelines
Incidental hepatosteatosis requires lifestyle modifications as the primary treatment, focusing on gradual weight loss, a balanced diet, and regular exercise, as recommended by the most recent guidelines 1. The management of incidental hepatosteatosis involves a stepwise approach to rule out advanced fibrosis, which is predictive of liver-related outcomes.
- Patients should be assessed for metabolic risk factors, such as obesity, diabetes mellitus, or dyslipidemia, and alternate causes for hepatic steatosis, such as significant alcohol consumption or medications 1.
- Lifestyle modification, including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption, is advised for adults with metabolic dysfunction-associated steatotic liver disease (MASLD) 1.
- Optimal management of comorbidities, including the use of incretin-based therapies for type 2 diabetes or obesity, is also recommended 1.
- Bariatric surgery is an option for individuals with MASLD and obesity, and resmetirom may be considered for adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and significant liver fibrosis 1. The goal of treatment is to prevent the progression of hepatosteatosis to more advanced liver disease, such as steatohepatitis, fibrosis, and cirrhosis, and to reduce the risk of liver-related complications and mortality.
- Regular monitoring with liver function tests every 6-12 months is advised, with referral to a hepatologist if there are signs of advanced disease 1.
- Early intervention through lifestyle changes can effectively reverse the condition in its early stages, improving morbidity, mortality, and quality of life outcomes.
From the Research
Incidental Hepatosteatosis: Prevalence and Reporting
- Incidental hepatosteatosis is a common finding on computed tomography (CT) scans performed for patients in the emergency department (ED) 2, 3.
- A study found that 26% of patients with suspected renal colic had hepatic steatosis measured by liver/spleen (L/S) ratio of ≤ 1.0 3.
- However, there are gaps in the reporting and evaluation of hepatic steatosis among radiologists and emergency clinicians, with only 28% of radiology reports noting steatosis in one study 3.
Management and Treatment
- The Canadian Association of Radiologists Incidental Findings Working Group has published guidelines for the management of hepatobiliary incidental findings, including hepatic steatosis and cirrhosis 4.
- Vitamin E and pioglitazone have shown beneficial effects in non-alcoholic fatty liver disease (NAFLD), with pioglitazone decreasing triglycerides and increasing high-density lipoproteins 5.
- An integrated approach to treating hepatic steatosis, including nutritional guidelines and nutraceutical administration, has been suggested, with one study finding significant reductions in anthropometric parameters and liver fibrosis and steatosis in patients treated with an herbal derivative based on Chrysanthellum americanum and Pistacia lentiscus L. extracts 6.
Communication and Documentation
- Clear communication between radiologists and ED physicians is important when incidental findings are encountered, with 60.2% of respondents in one study reporting that they would like hepatic steatosis to be mentioned in a CT report 2.
- However, documentation of hepatic steatosis in medical charts is often lacking, with only 19.1% of patients with reported steatosis having documentation in their medical charts in one study 3.