Macrovesicular steatosis in living related liver donors: correlation of biopsy findings with CT liver attenuation index and body mass index

Background: Hepatic steatosis threatens post-transplant graft survival; therefore, pre-operative quantification of steatosis is crucial. Gold standard for evaluation is donor liver biopsy but it is invasive. An alternative non-invasive method is a calculation of CT liver attenuation index. BMI can be an independent factor predicting grade of steatosis but it is necessary to re-define appropriate BMI cut-off points that are specific for Asians. Objective: To retrospectively analyze CT LAI and BMI for quantitative assessment of macro-vesicular steatosis in living related liver donors, using histological analysis as gold standard. Materials and Methods: A radiologist blinded to histological grading calculated mean CT hepatic attenuation in 48 potential living related liver donors. Results: CT-derived LAI correctly predicted steatosis in all except 1 patient. Parametric analysis for CT LAI and BMI showed overall weak positive correlation. No significant association was found between BMI and biopsy findings. Conclusion: Liver biopsy remains a gold standard for evaluation of steatosis. CT LAI of <= 0 correlates well with significant hepatic steatosis and biopsy may be avoided in such cases. Biopsy may be reserved for patients with CT LAI between 1 and 5. BMI alone is not a good predictor of hepatic steatosis in our study population.