Non-invasive diagnosis of severe alcoholic hepatitis: Usefulness of cross-sectional imaging - 15/10/20

Doi : 10.1016/j.diii.2020.09.009

F. Grillet ^a, P. Calame ^a,⁎ , J.-P. Cervoni ^b, D. Weil ^b, T. Thevenot ^b, M. Ronot ^c, E. Delabrousse ^a,^d
^a Department of Radiology, University of Bourgogne–Franche-Comté, CHRU of Besançon, 25030 Besançon, France
^b Department of Hepatology, University of Bourgogne–Franche-Comté, CHRU of Besançon, 25030 Besançon, France
^c Department of Radiology, University Hospitals Paris-Nord Val-de-Seine, AP–HP, Beaujon, 92110 Clichy, France
^d EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Bourgogne–Franche-Comté, Besançon, France

^⁎Corresponding author at: Service de radiologie, CHRU de Besançon, Hôpital Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon, France.Service de radiologie, CHRU de Besançon, Hôpital Jean-Minjoz3, boulevard FlemingBesançon25030France

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Highlights

•	The association of heterogenous steatosis and transient perfusion disorders in a large dysmorphic liver on CT/MRI is highly suggestive of severe alcohol hepatitis.
•	CT/MRI helps diagnose severe acute alcohol hepatitis.
•	Imaging findings of severe acute alcohol hepatitis are regressive over time.

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Abstract

Purpose

To describe the computed tomography (CT) and magnetic resonance imaging (MRI) features of severe acute alcoholic hepatitis (SAAH) and estimate the capabilities of CT and MRI in differentiating SAAH from alcoholic cirrhosis and non-alcoholic steato-hepatitis (NASH) cirrhosis.

Materials and methods

Fifty patients with pathologically proven SAAH (SAAH group) who underwent CT or MRI examinations up to 30 days before or 15 days after liver biopsy between January 2008 and June 2018 were retrospectively included. There were 31 men and 29 women with a mean age of 52±9 (SD) years (range: 33–67 years). Imaging features of the SAAH group were compared to those obtained in two control groups including 62 patients with alcoholic cirrhosis without acute alcoholic hepatitis (control group 1) and 19 patients with NASH cirrhosis (control group 2) by two independent radiologists blinded to the final diagnosis. Univariate analyses were performed to compare imaging characteristics between the three groups, followed by diagnostic performance analysis for the diagnosis of SAAH of the main CT features.

Results

Heterogeneous steatosis was significantly more frequent in SAAH group than in the control groups (41/50; 82% vs. 7/62; 10% and 1/19; 5% in control groups 1 and 2, respectively for reader 1 and 34/50; 68% vs. 8/62; 13% and 1/19; 5% in control groups 1 and 2, respectively for reader 2; both P=0.01). Transient perfusion disorders were more frequent in SAAH group than in the control groups (35/50; 70% vs. 12/62; 21% and 5/19; 26% in control groups 1 and 2, respectively for reader 1 and 39/50; 78% vs. 14/62; 23% and 13/19; 6% in control groups 1 and 2, respectively for reader 2; both P=0.01). The combination of these two findings yielded 100% specificity (45/45; 95% CI: 92–100) for readers 1 and 2 for the diagnosis of SAAH vs. alcoholic cirrhosis and NASH cirrhosis.

Conclusion

The imaging features of SAAH are specific and mainly associate transient heterogeneous steatosis and liver perfusion disorders. CT/MRI may be useful to differentiate SAAH from alcoholic cirrhosis and NASH cirrhosis.

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Keywords : Liver cirrhosis, Alcoholic hepatitis, Non-alcoholic steato-hepatitis, Multidetector computed tomography, Magnetic resonance imaging

Abbreviations : AAH, CT, MRI, NASH, PACS, SAAH