Non-invasive assessment of cirrhosis using multiphasic dual-energy CT iodine maps: correlation with model for end-stage
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HEPATOBILIARY
Non‑invasive assessment of cirrhosis using multiphasic dual‑energy CT iodine maps: correlation with model for end‑stage liver disease score Domenico Mastrodicasa1 · Martin J. Willemink1 · Celina Duran2 · Andrea Delli Pizzi3 · Virginia Hinostroza1 · Lior Molvin1 · Mohamed Khalaf1 · R. Brooke Jeffrey1 · Bhavik N. Patel1 Received: 22 August 2020 / Revised: 29 October 2020 / Accepted: 5 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To determine whether multiphasic dualenergy (DE) CT iodine quantitation correlates with the severity of chronic liver disease. Methods We retrospectively included 40 cirrhotic and 28 non-cirrhotic patients who underwent a multiphasic liver protocol DECT. All three phases (arterial, portal venous (PVP), and equilibrium) were performed in DE mode. Iodine (I) values (mg I/ml) were obtained by placing regions of interest in the liver, aorta, common hepatic artery, and portal vein (PV). Iodine slopes (λ) were calculated as follows: (Iequilibrium–Iarterial)/time and (Iequilibrium–IPVP)/time. Spearman correlations between λ and MELD scores were evaluated, and the area under the curve of the receiver operating characteristic (AUROC) was calculated to distinguish cirrhotic and non-cirrhotic patients. Results Cirrhotic and non-cirrhotic patients had significantly different λequilibrium-arterial [IQR] for the caudate (λ = 2.08 [1.39–2.98] vs 1.46 [0.76–1.93], P = 0.007), left (λ = 2.05 [1.50–2.76] vs 1.51 [0.59–1.90], P = 0.002) and right lobes (λ = 1.72 [1.12–2.50] vs 1.13 [0.41–0.43], P = 0.003) and for the PV (λ = 3.15 [2.20–5.00] vs 2.29 [0.85–2.71], P = 0.001). λequilibrium-PVP were significantly different for the right (λ = 0.11 [− 0.45–1.03] vs − 0.44 [− 0.83–0.12], P = 0.045) and left lobe (λ = 0.30 [− 0.25–0.98] vs − 0.10 [− 0.35–0.24], P = 0.001). Significant positive correlations were found between MELD scores and λequilibrium-arterial for the caudate lobe (ρ = 0.34, P = 0.004) and λequilibrium-PVP for the caudate (ρ = 0.26, P = 0.028) and right lobe (ρ = 0.33, P = 0.007). AUROC in distinguishing cirrhotic and non-cirrhotic patients were 0.72 (P = 0.002), 0.71 (P = 0.003), and 0.75 (P = 0.001) using λequilibrium-arterial for the left lobe, right lobe, and PV, respectively. The λequilibrium-PVP AUROC of the right lobe was 0.73 (P = 0.001). Conclusion Multiphasic DECT iodine quantitation over time is significantly different between cirrhotic and non-cirrhotic patients, correlates with the MELD score, and it could potentially serve as a non-invasive measure of cirrhosis and disease severity with acceptable diagnostic accuracy. Keywords Dual-energy CT · Liver cirrhosis · Iodine concentration · Material decomposition · Chronic liver disease
Introduction Liver disease is responsible for over 2 million deaths/year worldwide, and complications from cirrhosis account for about a half of these [1, 2]. Currently, liver biopsy is considered the reference standard for detection and grading of fibrosis [3, 4]. However, l
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