Hepatic attenuation on CT

Changed by Yuranga Weerakkody, 7 Feb 2023

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Disclosures - updated 10 May 2022: Nothing to disclose

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Hepatic attenuation on CT, reflected by Hounsfield values, depends on a combination of factors including the presence or absence, as well as the phase, of IV contrast administration.

Allowing for all these factors, the mean unenhanced attenuation value is around 55 HU ⁴.

Pathology

Several intrinsic liver pathologies can cause a diffuse change in liver attenuation with increased hepatic fat being the most prevalent.

Aetiology

Diffusely increased attenuation

iron deposition
- haemosiderosis
  - thalassaemia
- haemochromatosis: one paper suggests investigation for iron overload if unenhanced liver density is >75 HU ⁹
copper deposition
- Wilson disease
glycogen storage diseases
medications/drugs
- amiodarone hepatotoxicity: long-term amiodarone administration ^7,8,10
- gold therapy ⁶
previous Thorotrast administration

Diffusely decreased attenuation

diffuse hepatic steatosis (diffuse fatty liver)
diffuse malignant infiltration
diffuse non-malignant infiltrative disease (e.g. hepatic amyloidosis)

~~-<li>iron deposition<ul>~~
~~-<a href="/articles/haemosiderosis">haemosiderosis</a><ul><li><a href="/articles/thalassaemia">thalassaemia</a></li></ul>~~
~~-</li>~~
+iron deposition
+<ul>
~~-<a href="/articles/haemochromatosis">haemochromatosis</a>: one paper suggests investigation for iron overload if unenhanced liver density is >75 HU 9~~
+<a href="/articles/haemosiderosis">haemosiderosis</a>
+<ul><li><a href="/articles/thalassaemia">thalassaemia</a></li></ul>
+<li><a href="/articles/haemochromatosis">haemochromatosis</a>: one paper suggests investigation for iron overload if unenhanced liver density is >75 HU 9</li>
~~-<li>copper deposition<ul><li><a href="/articles/wilsons-disease">Wilson disease</a></li></ul>~~
~~-</li>~~
~~-<li><a href="/articles/glycogen-storage-disease">glycogen storage diseases</a></li>~~
~~-<li>medications/drugs<ul>~~
~~-<a href="/articles/amiodarone-deposition-in-the-liver">amiodarone hepatotoxicity</a>: long-term amiodarone administration 7,8~~
~~-</li>~~
~~-<li>gold therapy 6~~
+copper deposition
+<ul><li><a href="/articles/wilsons-disease">Wilson disease</a></li></ul>
+<li><a href="/articles/glycogen-storage-disease">glycogen storage diseases</a></li>
+<li>
+medications/drugs
+<ul>
+<li><a href="/articles/amiodarone-deposition-in-the-liver">amiodarone hepatotoxicity</a>: long-term amiodarone administration 7,8,10</li>
+<li>gold therapy 6</li>
~~-<li>previous <a href="/articles/thorotrast">Thorotrast </a>administration</li>~~
+<li>previous <a href="/articles/thorotrast">Thorotrast </a>administration</li>
~~-<li>~~
~~-<a href="/articles/diffuse-hepatic-steatosis">diffuse hepatic steatosis</a> (diffuse fatty liver)</li>~~
~~-<li>diffuse malignant infiltration</li>~~
~~-<li>diffuse non-malignant infiltrative disease (e.g. <a href="/articles/hepatic-amyloidosis">hepatic amyloidosis</a>)</li>~~
+<li><a href="/articles/diffuse-hepatic-steatosis">diffuse hepatic steatosis</a> (diffuse fatty liver)</li>
+<li>diffuse malignant infiltration</li>
+<li>diffuse non-malignant infiltrative disease (e.g. <a href="/articles/hepatic-amyloidosis">hepatic amyloidosis</a>)</li>

References changed:

10. Pecnik P, Ranftl V, Windpessl M. High Liver Density on CT Imaging Due to Amiodarone Toxicity. Wien Klin Wochenschr. 2018;130(5-6):220-1. <a href="https://doi.org/10.1007/s00508-018-1319-y">doi:10.1007/s00508-018-1319-y</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29396800">Pubmed</a>

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