Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_770_Библиотеки_им_академика_М_И_Перельмана

prevalence of MAFLD in the post-acute Covid syndrome [22].

• ECFs: extracolonic ndings

• moderate importance: usually benign but may

A combination of signs and symptoms together represent a syndrome. Metabolic syndrome is a risk factor that arises from IR together with abnormal adipose deposition and function. It increases risk of heart disease, stroke, and dia­betes [34]. The ATP III (American Treatment Panel) clinical denition of metabolic syn­drome [18] requires three or more of the fea­tures in Table19.3. Patients with this syndrome are four times more likely to have MAFLD than those who do not have the disease [19]. Those who have it have an approximate dou­bling of cardiovascular (CV) mortality risk [35]. Patients with MAFLD/NAFLD have been shown to be at increased risk of CVD, and it also contributes to accelerated atherogenesis [30]. It is estimated that 10% of patients with this fatty liver disease develop liver-related complications [5].

CVD [36] is the primary clinical outcome of this syndrome. Most people with the syndrome have IR. This in turn results in an increased risk of type 2 diabetes. When a patient is diabetic, CVD risk rises sharply. In addition to CVD and type 2 diabetes, patients with the syndrome are suscep­tible to the following.

In addition to the ATP III guidelines in Table 19.3, other organisations include different and additional criteria. The World Health Organisation (WHO) [37] includes: (1) IR which is required for diagnosis, (2) risk factors from high blood pressure, and (3) raised triglycerides, low HDL, increased body mass index (BMI), and microalbuminuria (urinary albumin excretion rate 20 μg min−1 or albumin creatinine ratio 30 mg G−1). The WHO underscores that early management of patients may have a signicant impact on prevention of both diabetes and CVD. The syndrome can be present for up to 10 years before detection of glycaemic disorders.

highly specic for assessing fatty liver inltra­tion. The HU reading of a healthy liver is between 60 and 65. When fatty inltration occurs, the liver becomes ‘darker’ on the scan; the HU value then drops to approximately 45. It is this inltra­tion that increases in extent when the HU value drops from 45 and often reaches 20–30 HU or less. Figure19.5a–g show a range of HU values of the liver. This indicates moderate-to-severe hepatic steatosis: at least 30% of the liver has been replaced by fat. Pickhardt etal. [43]. proved in their study that the use of unenhanced liver CT attenuation measurements were accurate and pre­cise for quantication of steatosis. An attenuation value of 45 HU or less was 100% specic for the biopsy proven moderate-to-severe steatosis [21]. Moderate steatosis, as stated in 19.1, is when unenhanced liver attenuation under 40HU corre­sponds to 15% proton fat fraction calculated from MRI [8]. In the absence of multiple blood trans­fusions, or amiodarone therapy, if the attenuation of unenhanced liver exceeds 75HU then iron overload must be considered [8].

A fatty liver as an ECF may in some patients show parts of the organ that have an absence of increased intracellular hepatic fat. It is important to take HU readings if this is noted. Figure19.7 shows fatty sparing. Literature underscores that nodular fatty sparing may, in error, be interpreted as a mass [48–50]. On an US examination, fatty sparing is hypoechoic or isoechoic [50].