Comparison of CT methods for determining graft steatosis in living donor liver transplantation

  • Mehmet ŞekerEmail author
  • Cengiz Erol
  • Şinasi Sevmiş
  • Burcu Saka
  • Afak Durur Karakaya



To evaluate and compare the diagnostic performance of non-enhanced computed tomography (NECT) and contrast-enhanced CT (CECT) attenuation indices in the assessment of hepatic steatosis by using biopsy as the reference standard.

Materials and methods

This retrospective study was approved by our Institutional Review Board. 55 Potential donors who underwent both NECT and triphasic CECT and core liver biopsy, were included the study. Average attenuation measurements that were obtained from multiple regions in liver, spleen, and psoas muscle on both unenhanced and CECT were used for analysis. Hepatic attenuation measurements were analyzed with and without normalization with the spleen and psoas muscle. Linear regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the statistical association between CT indices and steatosis at histology.


Linear regression analysis confirmed the strongest correlation between steatosis and normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT scan (R 0.821; R2 0.674 and R 0.816; R2 0.665, respectively). The use of ROC curve analysis also demonstrated that normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT showed high diagnostic performance regarding the qualitative distinction of steatosis (AUC values greater than 0.9).


Attenuation measurements of liver normalized with spleen on hepatic venous phase may be useful in evaluating steatosis in donor candidates with moderate to severe steatosis who are unacceptable for liver donation. In this manner unnecessary liver biopsy may be avoided in those donor candidates.


Hepatic steatosis Living donor liver transplantation (LDLT) Contrast-enhanced CT Non-enhanced CT 


Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to disclose.

Ethical approval

This study was approved by our Institutional Review Board.

Informed consent

All subjects gave written informed consent.

Supplementary material

261_2019_1993_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Faculty of MedicineMedipol UniversityIstanbulTurkey
  2. 2.Department of SurgeryYeni Yuzyıl UniversityIstanbulTurkey
  3. 3.Department of Pathology, Faculty of MedicineMedipol UniversityIstanbulTurkey

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