Correlation between Hepatic Attenuation and Visceral Fat Area on Computed Tomography: A Narrative Review

Abstract

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders worldwide and is closely associated with obesity, insulin resistance, metabolic syndrome, and increased visceral adiposity. Computed tomography (CT) has emerged as an important imaging modality for evaluating hepatic steatosis through quantitative assessment of hepatic attenuation values. Visceral fat area (VFA), measured on CT, is considered a significant indicator of metabolic dysfunction and cardiovascular risk. Recent studies have demonstrated a strong inverse relationship between hepatic attenuation and visceral fat accumulation, suggesting that increasing visceral obesity contributes to progressive hepatic fat deposition. This review summarizes the current evidence regarding the correlation between hepatic attenuation and visceral fat area on CT imaging, discusses CT-based diagnostic criteria for hepatic steatosis, and highlights the clinical implications of combining hepatic attenuation and visceral fat measurements in the assessment of metabolic liver disease. CT-derived hepatic attenuation and visceral fat area demonstrate a significant inverse correlation and together provide valuable imaging biomarkers for opportunistic screening, metabolic risk stratification, and longitudinal monitoring in patients with NAFLD.

Keywords: Hepatic attenuation; Visceral fat area; Computed tomography; Hepatic steatosis; Nonalcoholic fatty liver disease; Visceral obesity; Metabolic syndrome.