Postcontrast liver attenuation measured with coronary CT angiography demonstrated 'promising diagnostic performance for opportunistic identification of moderate-to-severe hepatic steatosis across different tube potential settings,' with optimal thresholds varying by tube potential.
Moderate-to-severe hepatic steatosis was present in 36.3% of patients undergoing coronary CT angiography.
Postcontrast liver attenuation demonstrated high diagnostic performance for detecting hepatic steatosis across all tube potential settings.
Optimal postcontrast liver attenuation thresholds for detecting steatosis decreased with increasing tube potential.
Patients with hepatic steatosis had a different distribution of coronary artery calcium scores compared to those without steatosis.
Hepatic steatosis was not associated with CAD-RADS categorization despite its association with coronary calcium burden.
This research suggests that a standard heart CT scan (coronary CT angiography, or CCTA) can be used to simultaneously screen for a common liver condition called hepatic steatosis (commonly known as 'fatty liver'), without requiring any additional imaging or radiation exposure. The study analyzed 300 patients who already had CCTA scans and found that liver fat could be detected with high accuracy by measuring how bright the liver appears on the contrast-enhanced images. Over a third of patients (36.3%) were found to have moderate-to-severe fatty liver, highlighting how common this condition is in people undergoing cardiac imaging. An important practical finding is that the brightness threshold used to identify fatty liver needs to be adjusted depending on the X-ray energy setting (tube potential) used during the scan. Higher energy settings require lower threshold values, meaning radiologists cannot apply a single universal cutoff. The study identified specific thresholds for three common energy settings (54 HU at 100 kVp, 47 HU at 120 kVp, and 40 HU at 140 kVp), providing actionable guidance for clinical use. The study also found that patients with fatty liver were more likely to have higher amounts of calcium buildup in their coronary arteries — a marker of atherosclerosis and heart disease risk — compared to patients without fatty liver. However, fatty liver was not associated with the severity of coronary artery narrowing as classified by the CAD-RADS system. This research suggests that routine cardiac CT scans could serve a dual purpose by opportunistically flagging patients who may have undiagnosed fatty liver disease, potentially enabling earlier intervention for a condition that can progress to serious liver damage if untreated.
Karahacioglu D, Cural Kula G, Kula S, Veznikli M, Boge M, Atasoy &. (2026). Opportunistic Detection of Hepatic Steatosis Using Postcontrast Liver Attenuation at Coronary CT Angiography.. Radiology. Cardiothoracic imaging. https://doi.org/10.1148/ryct.260148