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Protocol for measurement of liver fat by computed tomography

¹School of Physical and Health Education and ²Division of Endocrinology and Metabolism, Department of Medicine, Queen's University, Kingston, Ontario, Canada; and ³Centers for Integrated Health Research, The Cooper Institute, Dallas, Texas

Submitted 12 August 2005 ; accepted in final form 6 November 2005

To develop a protocol for measurement of liver fat using computed tomography (CT), we conducted a preliminary study with 118 men and 76 women to determine a readily identifiable vertebral landmark at which the CT image displayed both liver and spleen. Analysis of five landmarks revealed that the CT image obtained at the T₁₂–L₁ level simultaneously displayed the liver and spleen in 90% of the men and women. The T₁₂–L₁ protocol was cross-validated on a sample of 130 men and 113 women. In this sample, we also assessed the regional characteristics of liver and spleen tissue attenuation at the T₁₂–L₁ level by subdividing each image into quartiles from anterior to posterior, each of which were further divided into medial and lateral regions. A similar analysis was performed on images located 12 mm above and below T₁₂–L₁. The T₁₂–L₁ image displayed both liver and spleen in 92% (403 of 437) of the combined study sample. There was a significant (P < 0.005) stepwise increase in attenuation values [Hounsfield units (HU)] from the inferior to superior image. Although some significant (P < 0.05) differences were observed between the eight regions by comparison to the whole liver or spleen, the average magnitude of the difference was <2.0 HU for liver and <3.5 HU for spleen. Acquisition of a single CT image at the T₁₂–L₁ level is a practical and reliable method for routine measurement of liver fat in research and clinical settings.

liver attenuation; spleen; fatty liver; hepatic steatosis

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