Detection of Moderate Hepatic Steatosis on Portal Venous Phase Contrast-Enhanced CT: Evaluation Using an Automated Artificial Intelligence Tool

Pre-contrast CT is established to evaluate for hepatic steatosis; post-contrast CT has historically been limited for this purpose. To evaluate the diagnostic performance of portal venous phase post-contrast CT in detecting at least moderate hepatic steatosis using liver and spleen attenuation measurements determined by an automated artificial intelligence (AI) tool. This retrospective study included 2917 patients (mean age, 56.8 years; 1381 men, 1536 women) who underwent a CT examination including at least two series through the liver. Examinations were obtained from an AI vendor's data lake from 24 centers from one U.S. healthcare network and 29 centers from one Israeli healthcare network. An automated deep learning tool extracted liver and spleen attenuation measurements. Reference for at least moderate steatosis was pre-contrast liver attenuation 15%). A radiologist manually reviewed examinations with outlier AI results to confirm portal venous timing and identify issues impacting attenuation measurements. After outlier review, analysis included 2777 patients with portal venous phase images. Prevalence of at least moderate steatosis was 13.9% (387/2777). Patients without and with at least moderate steatosis had mean post-contrast liver attenuation of 104.5±18.1 HU and 67.1±18.6 HU (p