Background/Aims: Since the introduction of ultrasonography, liver steatosis has become an increasingly frequent diagnosis. Both ultrasonography (US) and computerized tomography (CT) provide qualitatitive rather than quantitative assessment of fatty infiltration. The objective of this study was to develop a noninvasive method for the quantification of the hepatic fat content in vivo. A test object containing solutions with CT scan density (CTD) similar to normal liver ('liver-equivalent') or 'fat-equivalent material' in variable proportions was prepared to measure patients with variable degrees of steatosis in vivo. Results: A linear correlation (r=0.99, p<0.001) linked CTD and the increasing percentage of fat-equivalent material. A CTD calibration curve was derived as a reference for the in vivo determinations. In 29 consecutive patients with steatosis diagnosed by histology, CTD was linearly correlated (r=0.83, p< 0.001) with the hepatic fat content (HFC) expressed as percent of the whole liver, obtained by a computerized histomorphometric analysis. Based on the calibration curve obtained in 29 subjects who underwent liver biopsy, 38 additional consecutive steatotic patients were examined and the degree of hepatic fat content was calculated. The HFC was linearly correlated (r=-0.86, p<0.001) with the liver-to-spleen ratio. Conclusions: We conclude that the use of test objects allows an accurate and reproducible noninvasive quantitative assessment of hepatic fat infiltration in humans. This technique may prove useful in the evaluation of the natural course and treatment of hepatic steatosis as well as in the assessment of donor livers prior to transplantation.
