Patterns of Fatty Liver Disease

This article reviews the imaging findings of hepatic steatosis (fatty liver disease) on cross-sectional imaging with an emphasis on various patterns of focal fat. Hepatic steatosis can herald pathology or mimic metastatic disease, the latter generating confusion and creating undue patient anxiety. Hepatic steatosis is often first detected at computed tomography imaging, which serves as the primary imaging modality for evaluating a wide variety of diseases within the abdomen and pelvis. However, magnetic resonance imaging (MRI) has evolved as a more precise method of evaluating for the presence, severity, and distribution of hepatic steatosis. In particular, chemical shift MRI is a robust technique that is invaluable in differentiating between focal fat and its mimics, allowing the radiologist to establish a confident diagnosis while preventing unnecessary biopsies.