Effects of niacin therapy that simulate neoplasia: hepatic steatosis with concurrent hepatic dysfunction

Niacin, a widely used antihyperlipidemic agent, can produce hepatic steatosis and clinical hepatic abnormalities that together simulate the presentation of hepatobiliary neoplasia. We describe a patient initially suspected of having hepatobiliary neoplasia for whom imaging studies played a pivotal role in reaching the correct diagnosis of niacin-induced hepatotoxicity. Radiologists should become knowledgeable of these niacin-related effects, add niacin effects to the differential diagnosis of hepatic steatosis, and understand the value of correlative imaging in distinguishing these effects from hepatobiliary neoplasia.