CT and US provide chance for fatty liver disease screening

By AuntMinnie.com staff writers

May 25, 2021 -- Abdominal CT and ultrasound can be useful tools for opportunistic screening for hepatic steatosis, or fatty liver disease, according to a study published May 24 in the Journal of the American College of Radiology.

Hepatic steatosis is a common incidental finding on abdominal imaging, a group led by Dr. Rubal Penna of Virginia Mason Medical Center in Seattle noted. But it's not always taken seriously, despite the fact that it is associated with liver disease, cirrhosis, and diabetes.

In the new study, Penna's group explored whether adding a standardized note regarding incidentally identified hepatic steatosis to a patient's radiology report would not only help referring clinicians follow up but also identify significant disease.

The study included 1,256 patients who underwent either CT or ultrasound and whose reports included a note about the presence of hepatic steatosis between April 2016 and September 2017. The researchers assessed whether any follow-up clinical action had been taken in response, tracking patient demographics, type of referring provider, and urgency of exam results.

Follow-up was more likely for patients whose exams had been ordered by primary care providers, whose exam results weren't urgent, and who had undergone ultrasound. Follow-up of the study cohort found fatty liver disease in 70%, nonalcoholic steatohepatitis in 6%, and alcoholic hepatitis in 17%.

"Opportunistic screening for incidental hepatic steatosis on abdominal CT and ultrasound is feasible, with substantial yield for patients with clinically important entities including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis," the team concluded.

US Screening during wellness visits spots abnormalities in 94% of patients

Matt O'Connor | July 21, 2021 | Diagnostic & Screening

Ultrasound screening during annual visits for older patients frequently identifies abnormalities and new chronic conditions. And implementing these exams during wellness visits may be highly beneficial, authors argued in a new analysis.

Standard Medicare Wellness checkups require no physical exam beyond blood pressure, and many doctors perform limited assessments in these situations, authors wrote in the Journal of Ultrasound in Medicine. But providers from Minneapolis-based Allina Health instituted a primary care clinic US program to determine the benefits of preventative ultrasound.

The effort proved successful, leading to meager follow-up testing costs and high patient acceptance marks.

“One or more abnormalities were found in 94% of our participants, the great majority of which would have been undetected by a traditional physical exam.

The program employed an experienced physician to perform US screening in patients 65-85 years old during their annual Medicare Wellness visits. Overall, only 108 people were examined, leading to 283 abnormalities and 172 new diagnoses.

Abdominal findings most often included liver steatosis and kidney cysts, while cardiovascular abnormalities typically consisted of carotid plaque, tricuspid valve regurgitation and left ventricular diastolic dysfunction.

Doctors ordered 30 total follow-ups, resulting in no added costs for 76% of patients. Fifteen percent faced tabs between $5-$50.

Rosborough and co-authors said screening during these appointments is at least “mildly beneficial,” but more research is needed.

“A larger study with multiple US-enabled physicians would be required to assess the generalizability and cost-effectiveness of an US screening exam as part of a wellness visit,” the authors added. “We continue to investigate how to implement an US screening exam for select patients having periodic health visits.”