Hepatic attenuation on CT

Last revised by Arlene Campos ◉ on 19 Feb 2025

Citation, DOI, disclosures and article data

Citation:

Weerakkody Y, Elfeky M, Gevorgyan E, et al. Hepatic attenuation on CT. Reference article, Radiopaedia.org (Accessed on 28 Mar 2025) https://doi.org/10.53347/rID-8020

DOI:

https://doi.org/10.53347/rID-8020

Permalink:

https://radiopaedia.org/articles/8020?embed_domain=external.radpair.com

rID:

8020

Article created:

4 Jan 2010, Yuranga Weerakkody ◉

Disclosures:

At the time the article was created Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Last revised:

19 Feb 2025, Arlene Campos ◉

Disclosures:

At the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.

View Arlene Campos's current disclosures

Revisions:

21 times, by 11 contributors - see full revision history and disclosures

Systems:

Hepatobiliary

Sections:

Gamuts

Tags:

liver, cases

Synonyms:

Descreased hepatic attenuation
Increased hepatic attenuation
High attenuation - Liver
Low attenuation - Liver
Hyperdense liver
Hyperdensity of the liver
Hepatic hyperdensity
Hypodensity of the liver
Hepatic hypodensity

Hepatic attenuation on CT, reflected by Hounsfield values, depends on a combination of factors including the presence or absence, as well as the phase, of IV contrast administration.

Allowing for all these factors, the mean unenhanced attenuation value is around 55 HU ⁴.

Pathology

Several intrinsic liver pathologies can cause a diffuse change in liver attenuation with increased hepatic fat being the most prevalent.

Aetiology

Diffusely increased attenuation

iron deposition
- haemosiderosis
  - thalassaemia
- haemochromatosis: one paper suggests investigation for iron overload if unenhanced liver density is >75 HU ⁹
copper deposition
- Wilson disease
glycogen storage diseases
medications/drugs
- amiodarone hepatotoxicity: long-term amiodarone administration ^7,8,10
- gold therapy ⁶
previous Thorotrast administration

Diffusely decreased attenuation

diffuse hepatic steatosis (diffuse fatty liver)
diffuse malignant infiltration
diffuse non-malignant infiltrative disease (e.g. hepatic amyloidosis)

Quiz questions

References

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2. Jacobs JE, Birnbaum BA, Shapiro MA et-al. Diagnostic criteria for fatty infiltration of the liver on contrast-enhanced helical CT. AJR Am J Roentgenol. 1998;171 (3): 659-64. AJR Am J Roentgenol (link) - Pubmed citation
3. Mergo PJ, Ros PR, Buetow PC et-al. Diffuse disease of the liver: radiologic-pathologic correlation. Radiographics. 1994;14 (6): 1291-307. Radiographics (link) - Pubmed citation
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7. Markos J, Veronese ME, Nicholson MR et-al. Value of hepatic computerized tomographic scanning during amiodarone therapy. Am. J. Cardiol. 1985;56 (1): 89-92. Am. J. Cardiol. (link) - Pubmed citation
8. Nicholson AA, Caplin JL, Steventon DM. Measurement of tissue-bound amiodarone and its metabolites by computed tomography. Clin Radiol. 1994;49 (1): 14-8. - Pubmed citation
9. Lawrence EM, Pooler BD, Pickhardt PJ. Opportunistic Screening for Hereditary Hemochromatosis With Unenhanced CT: Determination of an Optimal Liver Attenuation Threshold. (2018) AJR. American journal of roentgenology. doi:10.2214/AJR.18.19690 - Pubmed
10. Pecnik P, Ranftl V, Windpessl M. High Liver Density on CT Imaging Due to Amiodarone Toxicity. Wien Klin Wochenschr. 2018;130(5-6):220-1. doi:10.1007/s00508-018-1319-y - Pubmed