Reverse computer tomographic (CT) pattern of vacuolar hepatopathy with fat accumulation in canine and feline liver

Introduction/purpose
\nDifferent conditions can lead to severe vacuolar hepatopathy with fat accumulation in
\ncanine and feline liver. Hepatic lipidosis, in cats, usually results from chronic anorexia
\nand weight loss due to different causes. In dogs, steatosis is generally associated with
\ndiabetes mellitus and with hepatocellular vacuolar changes occurring in canine
\nhyperadrenocorticism. The definitive diagnosis is histological, but ultrasonographic or
\ntomographic images may allow a non-invasive description of vacuolar hepatopathy. In
\nhuman medicine, unenhanced CT is considered the best way to assess fat accumulation
\nwithin the liver. The aim of the study was to describe an uncommon tomographic
\npattern of canine and feline vacuolar hepatopathy with fat accumulation.
\nMethods
\nOne Labrador retriever and one domestic shorthair cat were referred to our centers
\nafter hematology, biochemistry and abdominal ultrasound, for a total body CT due to a
\nsuspicion of hyperadrenocorticism syndrome and hepatic disease, respectively. Blood
\ntests revealed an increase of liver enzymes in both animals, albumin/globulin ratio in
\nthe cat and blood urea nitrogen, glucose and triglycerides in the dog. Ultrasonography
\nshowed an increased liver echogenicity and - in the dog - increase in size of the left
\nadrenal gland. Plain and post-contrast (600 mg/kg i.v. Iodine) total body CT acquisition
\nwith soft tissue algorithm was performed. Circular regions of interest (ROI) with an
\narea of 2 cm2 were drawn over the liver avoiding major hepatic and portal vessels. For
\neach ROI, mean (standard deviation, SD) attenuation values (HU, Hounsfield Units)
\nwere recorded. Mean (SD) hepatic attenuation values of the two investigated animals
\nwere compared to the mean (SD) hepatic attenuation values measured in 10 dogs and
\n10 cats which underwent CT for unrelated liver diseases, used as control. Fine needle
\naspiration (FNA) and tissue core biopsy of the liver were also performed in the cat and
\nin the dog, respectively.
\nResults
\nOn pre-contrast images, the liver of the dog had a mean (SD) hepatic attenuation
\nvalue of -18,39 HU (12,78) (Fig. 1), while the liver of the cat had attenuation of -25,04
\nHU (7,15) (Fig. 2). The average of the mean (SD) hepatic attenuation values in all
\ndogs without hepatic diseases was 63,85 HU (12,03), while it was 55,25 HU (6,77) in
\nthe cats with normal liver. Post-contrast CT images revealed a mean (SD) hepatic
\nattenuation value of 30,04 HU (15,7) in the dog and 25,61 (10,48) in the cat. The
\ncontrol animals presented an average of the mean (SD) hepatic attenuation values of
\n136,28 (15,02) in dogs and 129,25 (9,66) in cats. (Fig. 3). The tomographic diagnosis
\nof lipidosis in the cat and steatosis/hyperadrenocorticism in the dog were confirmed by
\ncytological and histopathological examination, respectively.
\nDiscussion/Conclusions
\nNegative hepatic attenuation values with fat storage describe a hypoattenuating
\nreverse CT pattern of the parenchyma, when compared to hepatic vascular structures.

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