Incidental hepatic steatosis on unenhanced computed tomography performed for suspected renal colic: Gaps in reporting and documentation.
INTRODUCTION
Hepatic steatosis is a common incidental finding on computed tomography (CT) in patients presenting to the emergency department (ED). The aims of our study were to assess the prevalence of hepatic steatosis in ED patients with suspected renal colic and to assess documentation in radiology reports and medical charts correlated with alanine transaminase (ALT) levels.


METHODS
Over 18 months from January 2016 to June 2017, all unenhanced CTs performed for suspected renal colic were reviewed. Quantitative assessment measuring hepatic and splenic attenuation in Hounsfield Units was performed. Hepatic steatosis was defined using multiple CT criteria including liver/spleen (L/S) ratio. Radiology reports, medical charts and ALT levels, if collected within 24 h of CT, were reviewed.


RESULTS
A total of 1290 patients were included with a median age 52.5 years (range 16-98) and male predominance (835 [64.7%]). A total of 336 (26%) patients had hepatic steatosis measured by L/S ratio of ≤ 1.0. Ninety-four patients (28%) had radiology reports noting steatosis. Documentation in medical charts was noted in 18 of the 94 patients (19.1%) for whom steatosis was reported. Liver enzymes were available for 704 (54.6%) patients. There was a significantly higher mean ALT level in patients with hepatic steatosis (42.2 U/L; 95% CI 38.4-46.0) compared to patients without (28.8 U/L; 95% CI 25.7-31.9) (P < 0.0001).


CONCLUSION
Our findings highlight multiple gaps in the reporting and evaluation of hepatic steatosis among radiologists and emergency clinicians alike. Recognising and reporting this incidental finding may impact health outcomes.
['Kutaiba|Numan|N|https://orcid.org/0000-0003-4627-9847', 'Richmond|Danielle|D|', 'Morey|Matthew|M|', 'Brennan|Daniel|D|', 'Rotella|Joe-Anthony|JA|', 'Ardalan|Zaid|Z|', 'Goodwin|Mark|M|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000410:Alanine Transaminase D005234:Fatty Liver D005260:Female D006801:Humans D033162:Incidental Findings D008099:Liver D008297:Male D008499:Medical Records D008875:Middle Aged D056844:Renal Colic D012189:Retrospective Studies D014057:Tomography, X-Ray Computed D055815:Young Adult
computed tomography incidental findings alanine transaminase fatty liver non-alcoholic fatty liver disease