Abdominal Radiology

, Volume 42, Issue 5, pp 1374–1392 | Cite as

Imaging patterns and focal lesions in fatty liver: a pictorial review

  • Sudhakar K. VenkateshEmail author
  • Tiffany Hennedige
  • Geoffrey B. Johnson
  • David M. Hough
  • Joel G. Fletcher
Pictorial Essay


Non-alcoholic fatty liver disease is the most common cause of chronic liver disease and affects nearly one-third of US population. With the increasing trend of obesity in the population, associated fatty change in the liver will be a common feature observed in imaging studies. Fatty liver causes changes in liver parenchyma appearance on imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) and may affect the imaging characteristics of focal liver lesions (FLLs). The imaging characteristics of FLLs were classically described in a non-fatty liver. In addition, focal fatty change and focal fat sparing may also simulate FLLs. Knowledge of characteristic patterns of fatty change in the liver (diffuse, geographical, focal, subcapsular, and perivascular) and their impact on the detection and characterization of FLL is therefore important. In general, fatty change may improve detection of FLLs on MRI using fat suppression sequences, but may reduce sensitivity on a single-phase (portal venous) CT and conventional ultrasound. In patients with fatty liver, MRI is generally superior to ultrasound and CT for detection and characterization of FLL. In this pictorial essay, we describe the imaging patterns of fatty change in the liver and its effect on detection and characterization of FLLs on ultrasound, CT, MRI, and PET.


Fatty liver Hepatic steatosis Focal liver lesions Ultrasound CT MRI PET 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was waived for this retrospective review of images.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sudhakar K. Venkatesh
    • 1
    Email author
  • Tiffany Hennedige
    • 2
  • Geoffrey B. Johnson
    • 1
  • David M. Hough
    • 1
  • Joel G. Fletcher
    • 1
  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.Department of Oncologic ImagingNational Cancer CentreSingaporeSingapore

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