Potential of Electron Beam Computed Tomography for Coronary Artery Calcium Screening to Evaluate Fatty Liver: Comparison with 1H Magnetic Resonance Spectroscopy in the Dallas Heart Study

Abstract

Objectives

Electron beam computed tomography (EBCT) for coronary artery calcification can potentially evaluate liver fat, another marker of cardiovascular risk. We compared quantitative estimates of hepatic steatosis measured by EBCT with those obtained by a well-validated, accurate-measure, magnetic resonance spectroscopy (¹H MRS).

Methods

EBCT and ¹H MRS were performed in 2159 subjects from the Dallas Heart Study. Forty subjects were randomly selected from each of 5 subgroups of liver fat percent by ¹H MRS (n = 200). EBCT average liver attenuation (HU) was determined in a 1- to 2-cm circular region of interest over the liver lobes. Pearson correlation coefficients were calculated. Using a previously defined ¹H MRS hepatic steatosis cut point (>5.5%), an optimized EBCT liver attenuation cut point was determined by receiver operating characteristic analysis.

Results

¹H MRS liver fat content and EBCT average right lobe liver attenuation were moderately negatively correlated (r = −0.64, P < 0.0001) in all subjects and in those with ¹H MRS hepatic steatosis (r = −0.71, P < 0.0001). This correlation did not improve with attenuation correction of the EBCT data using a standard calcium phantom or statistical transformation. Using an optimized receiver operating characteristic EBCT cut point (64.5 HU), sensitivity was 78% and specificity was 72% for detecting ¹H MRS hepatic steatosis, with a high false negative rate. Risk factors for hepatic steatosis (obesity, diabetes mellitus, insulin resistance, metabolic syndrome) were more strongly correlated with ¹H MRS than EBCT liver fat measures.

Conclusions

Liver attenuation on EBCT acquired for coronary artery calcification screening correlates modestly with ¹H MRS measures of liver fat content, with a high false negative rate.