Hepatosplenic volumetric assessment at MDCT for staging liver fibrosis
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To investigate hepatosplenic volumetry at MDCT for non-invasive prediction of hepatic fibrosis.
Hepatosplenic volume analysis in 624 patients (mean age, 48.8 years; 311 M/313 F) at MDCT was performed using dedicated software and compared against pathological fibrosis stage (F0 = 374; F1 = 48; F2 = 40; F3 = 65; F4 = 97). The liver segmental volume ratio (LSVR) was defined by Couinaud segments I–III over segments IV–VIII. All pre-cirrhotic fibrosis stages (METAVIR F1-F3) were based on liver biopsy within 1 year of MDCT.
LSVR and total splenic volumes increased with stage of fibrosis, with mean(±SD) values of: F0: 0.26 ± 0.06 and 215.1 ± 88.5 mm3; F1: 0.25 ± 0.08 and 294.8 ± 153.4 mm3; F2: 0.331 ± 0.12 and 291.6 ± 197.1 mm3; F3: 0.39 ± 0.15 and 509.6 ± 402.6 mm3; F4: 0.56 ± 0.30 and 790.7 ± 450.3 mm3, respectively. Total hepatic volumes showed poor discrimination (F0: 1674 ± 320 mm3; F4: 1631 ± 691 mm3). For discriminating advanced fibrosis (≥F3), the ROC AUC values for LSVR, total liver volume, splenic volume and LSVR/spleen combined were 0.863, 0.506, 0.890 and 0.947, respectively.
Relative changes in segmental liver volumes and total splenic volume allow for non-invasive staging of hepatic fibrosis, whereas total liver volume is a poor predictor. Unlike liver biopsy or elastography, these CT volumetric biomarkers can be obtained retrospectively on routine scans obtained for other indications.
• Regional changes in hepatic volume (LSVR) correlate well with degree of fibrosis.
• Total liver volume is a very poor predictor of underlying fibrosis.
• Total splenic volume is associated with the degree of hepatic fibrosis.
• Hepatosplenic volume assessment is comparable to elastography for staging fibrosis.
• Unlike elastography, volumetric analysis can be performed retrospectively.
KeywordsMDCT Cirrhosis Liver fibrosis Volume Volumetric analysis
The scientific guarantor of this publication is PJ Pickhardt. The authors of this manuscript declare relationships with the following companies: Dr. Pickhardt is co-founder of VirtuoCTC and shareholder in Cellectar Biosciences, Elucent and SHINE. This study has received funding support from Philips and the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board for this retrospective study. A sub-cohort has been previously reported in the initial validation trial . Methodology: retrospective, cross-sectional, performed at one institution.
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