Quantification of liver extracellular volume using dual-energy CT: utility for prediction of liver-related events in cir
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HEPATOBILIARY-PANCREAS
Quantification of liver extracellular volume using dual-energy CT: utility for prediction of liver-related events in cirrhosis Seongjun Bak 1 & Ji Eun Kim 1 & Kyungsoo Bae 1 & Jae Min Cho 1 & Ho Cheol Choi 1 & Mi Jung Park 1 & Hye Young Choi 1 & Hwa Seon Shin 1 & Sang Min Lee 1 & Hyun Ok Kim 2 Received: 12 November 2019 / Revised: 22 January 2020 / Accepted: 8 April 2020 # European Society of Radiology 2020
Abstract Objectives To determine whether quantification of liver extracellular volume fraction (fECV) using dual-energy CT (DECT) allows prediction of liver-related events (LREs) in cirrhotic patients. Methods This retrospective study included 305 cirrhotic patients who underwent dual-source DECT imaging and had serum markers analyzed within 2 weeks of initial CT imaging. The fECV score was measured using an iodine map of equilibrium-phase images obtained 3 min after contrast injection at 100/140 Sn kVp. The association of the fECV score and serum markers with LREs was investigated. A risk model combining the fECV score (< 27 versus ≥ 27%) and serum albumin level (< 4 versus ≥ 4 g/ dL) was constructed for LRE prediction. Results An increased fECV score (odds ratio, 1.27; 95% confidence interval (CI), 1.15, 1.40) was independently associated with decompensated cirrhosis at baseline (n = 85) along with the Model for End-Stage Liver Disease score (odds ratio, 1.32; 95% CI, 1.07, 1.63). Among patients with compensated cirrhosis, 10.5% (23 of 220) experienced LREs during the median follow-up period of 2.0 years (decompensation, n = 14; hepatocellular carcinoma, n = 9). The fECV score (hazard ratio, 1.40; 95% CI, 1.22, 1.62) and serum albumin level (hazard ratio, 0.26; 95% CI, 0.09, 0.73) were independent predictors of LRE. The mean times to LRE among the high (16.5 months, n = 18)-, intermediate (25.6 months, n = 44)-, and low (30.5 months, n = 158)-risk groups were significantly different (p < 0.001). Conclusions The fECV score derived from DECT allows prediction of LREs in cirrhotic patients. Key Points • The extracellular volume fraction (fECV) score derived from the iodine map of dual-energy CT (DECT) was independently associated with the presence of hepatic decompensation. • The fECV score derived from the iodine map of DECT can predict liver-related events (LREs) in patients with cirrhosis. • Equilibrium-phase scanning in dual-energy mode is recommended as part of liver CT in cirrhotic patients because it can provide a prognostic indicator for LRE development. Keywords Liver cirrhosis . Tomography, X-ray computed . Extracellular space . Iodine
* Ji Eun Kim [email protected] 1
Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Republic of Korea
2
Department of Internal Medicine, Gyeongsang National University College of Medicine and Changwon Gyeongsang National University Hospital, Jinju, Republic of Korea
Abbreviations AIC Akaike information criterion CART Classification and regre
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