1793. Missed Opportunity to Increase Obese Patients’ and Their Physicians’ Awareness of Moderate to Severe Hepatic Steatosis Utilizing CT Studies
Authors * Denotes Presenting Author
  1. Ruixue Zhang *; University of Hawaii
  2. Bradley Thomas; University of Hawaii
  3. Melia Takakusagi; University of Hawaii
  4. Hyo-Chun Yoon; University of Hawaii
Measuring the Hounsfield attenuation of the liver allows for the diagnosis of moderate to severe hepatic steatosis in patients undergoing CT studies that include the liver for indications not related to fatty liver disease. The purpose of this study was to evaluate the variability in the radiologists’ reporting of hepatic steatosis in patients with moderate to severe hepatic steatosis and the correlation to the presence or absence of the diagnosis in the patients’ electronic medical record (EMR).

Materials and Methods:
Subjects evaluated were all members of a geographically isolated integrated healthcare system who self-identified as Asian or Pacific Islander, were obese at the time of CT, and were 18-50 years of age. We measured the liver attenuation on CT studies and those with an attenuation less than published cutoff values for contrast-enhanced and unenhanced CT studies were deemed positive for moderate to severe hepatic steatosis. The reports of CT studies deemed positive for moderate to severe hepatic steatosis were then reviewed. We recorded whether there was a mention of hepatic steatosis-related terms either in the findings section, the impression section, or both. We recorded the descriptive terminologies used by radiologists and reviewed patient EMRs to verify if a diagnosis of hepatic steatosis was present in their problem lists.

There was a total of 748 Asian or Pacific Islander patients who were obese, 18-50 years old, and had CT scans including the liver. Of these patients, 310 subjects had CT studies that demonstrated moderate to severe hepatic steatosis. In 184 (59.4%) reports associated with these CT studies, the radiologist mentioned hepatic steatosis either in the findings or impression section in the reports. Fifty-one of the 184 subjects (27.7%) with hepatic steatosis mentioned in the radiology report had a related diagnosis listed in their EMR problem list. Thus, only 16.5% of all 310 subjects with moderate to severe hepatic steatosis had a hepatic steatosis related diagnosis in the EMR. Terminologies used to describe hepatic steatosis varied among radiologists, including diffuse fatty infiltration, enlarged fatty liver, and hepatic steatosis. However, none mentioned the severity of the hepatic steatosis.

Moderate to severe hepatic steatosis is underreported by radiologists as an incidental finding on CT studies that include the liver which may represent an important missed opportunity to identify which patients may benefit from counseling and lifestyle modifications.