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Accuracy of liver surface nodularity quantification on MDCT for staging hepatic fibrosis in patients with hepatitis C virus



To evaluate semi-automated measurement of liver surface nodularity (LSN) on MDCT in a cause-specific cohort of patients with chronic hepatitis C virus infection (HCV) for identification of hepatic fibrosis (stages F0–4).


MDCT scans in patients with known HCV were evaluated with an independently validated, semi-automated LSN measurement tool. Consecutive LSN measurements along the anterior liver surface were performed to derive mean LSN scores. Scores were compared with METAVIR fibrosis stage (F0–4). Fibrosis stages F0–3 were based on biopsy results within 1 year of CT. Most patients with cirrhosis (F4) also had biopsy within 1 year; the remaining cases had unequivocal clinical/imaging evidence of cirrhosis and biopsy was not indicated.


288 patients (79F/209M; mean age, 49.7 years) with known HCV were stratified based on METAVIR fibrosis stage: F0 (n = 43), F1 (n = 29), F2 (n = 53), F3 (n = 37), and F4 (n = 126). LSN scores increased with increasing fibrosis (mean: F0 = 2.3 ± 0.2, F1 = 2.4 ± 0.3, F2 = 2.6 ± 0.5, F3 = 2.9 ± 0.6, F4 = 3.8 ± 1.0; p < 0.001). For identification of significant fibrosis (≥ F2), advanced fibrosis (≥ F3), and cirrhosis (≥ F4), the ROC AUCs were 0.88, 0.89, and 0.90, respectively. The sensitivity and specificity for significant fibrosis (≥ F2) using LSN threshold of 2.80 were 0.68 and 0.97; for advanced fibrosis (≥ F3; threshold = 2.77) were 0.83 and 0.85; and for cirrhosis (≥ F4, LSN threshold = 2.9) were 0.90 and 0.80.


Liver surface nodularity assessment at MDCT allows for accurate discrimination of intermediate stages of hepatic fibrosis in a cause-specific cohort of patients with HCV, particularly at more advanced levels.

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Correspondence to Meghan G. Lubner.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The need for informed consent was waived.


MGL: Grant funding—Philips, Ethicon. PJP: Co-founder, VirtuoCTC, Advisor to Check-Cap, Shareholder in Cellectar, Elucent, SHINE and for other authors there are no relevant disclosures.

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Lubner, M.G., Jones, D., Said, A. et al. Accuracy of liver surface nodularity quantification on MDCT for staging hepatic fibrosis in patients with hepatitis C virus. Abdom Radiol 43, 2980–2986 (2018).

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  • Computed tomography
  • Liver surface nodularity
  • Hepatitis C virus
  • Liver fibrosis