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Comparison between CT volumetry and extracellular volume fraction using liver dynamic CT for the predictive ability of liver fibrosis in patients with hepatocellular carcinoma

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To compare the predictive ability of liver fibrosis (LF) by CT-volumetry (CTV) for liver and spleen and extracellular volume fraction (ECV) for liver in patients undergoing liver resection.

Methods

We retrospectively analysed 90 consecutive patients who underwent CTV and ECV. Manually placed region-of-interest ECV (manual-ECV), rigid-registration ECV (rigid-ECV), and nonrigid-registration ECV (nonrigid-ECV) were calculated as ECV(%) = (1-haematocrit) × (ΔHUliver/ΔHUaorta), where ΔHU = subtraction of unenhanced phase from equilibrium phase (240 s). Manual-ECV was compared with CTV for the estimation of LF. The total liver volume to body surface area (TLV/BSA), splenic volume to BSA (SV/BSA), ratio of TLV to SV (TLV/SV), ratio of right liver volume to SV (RV/SV), and liver segmental volume ratio (LSVR) were measured. ROC analyses were performed for ECV and CTV.

Results

After excluding 10 patients, seventy-eight (97.5%) out of 80 patients had a Child-Pugh score of 5 points, and two (2.5%) patients had a Child-Pugh score of 6 points. AUC of ECV showed no significant difference among manual-ECV, rigid-ECV, and nonrigid-ECV. TLV/BSA, SV/BSA, TLV/SV, and RV/SV had a higher correlation with LF grades than manual-ECV. AUC of SV/BSA was significantly higher than that of manual-ECV in F0-1 vs F2-4 and F0-2 vs F3-4. AUC of SV/BSA (0.76–0.83) was higher than that of manual-ECV (0.61–0.75) for all LF grades, although manual-ECV could differentiate between F0-3 and F4 at high AUC (0.75).

Conclusions

In patients undergoing liver resection, SV/BSA is a better method for estimating severe LF grades, although manual-ECV has the ability to estimate cirrhosis (≥ F4).

Key Points

  • The splenic volume is a better method for estimating liver fibrosis grades.

  • The extracellular volume fraction is also a candidate for the estimation of severe liver fibrosis.

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Abbreviations

APRI:

Aspartate aminotransferase-platelet ratio index

BSA:

Body surface area

Cr:

Creatinine

CTV:

Computerised tomography volumetry

ECV:

Extracellular volume fraction

FIB-4:

Fibrosis index based on the four factors

Hct:

Haematocrit

ICGR15:

Indocyanine green retention rates at 15 minutes after injection

INR:

International normalised ratio

LF:

Liver fibrosis

LSVR:

Liver segmental volume ratio, which is volume ratio of Couinaud segments I-III to segmnts IV-VIII

manual-ECV:

ECV by manually placed region-of-interests

nonrigid-ECV:

Nonrigid registration ECV

Plt:

Platelet count

rigid-ECV:

Rigid registration ECV

RV/SV:

Ratio of RV to SV

RV:

Right liver volume

SV:

Splenic volume

TLV/SV:

Ratio of TLV to SV

TLV:

Total liver volume

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Acknowledgements

The authors would like to acknowledge all of the patients for their willingness to participate in the study.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Departments of Radiology of Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan

    Kenichiro Tago, Jitsuro Tsukada, Naohiro Sudo, Kazu Shibutani, Masahiro Okada & Kenji Ibukuro

  2. Departments of Digestive Surgery Nihon University School of Medicine, Tokyo, Japan

    Hayato Abe, Tokio Higaki & Tadatoshi Takayama

Authors
  1. Kenichiro Tago
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  2. Jitsuro Tsukada
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  3. Naohiro Sudo
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  4. Kazu Shibutani
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  5. Masahiro Okada
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  6. Hayato Abe
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  7. Kenji Ibukuro
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  8. Tokio Higaki
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  9. Tadatoshi Takayama
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Correspondence to Masahiro Okada.

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The scientific guarantor of this publication is Masahiro Okada.

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Institutional Review Board approval was obtained.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because of the retrospective nature of this study.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Tago, K., Tsukada, J., Sudo, N. et al. Comparison between CT volumetry and extracellular volume fraction using liver dynamic CT for the predictive ability of liver fibrosis in patients with hepatocellular carcinoma. Eur Radiol 32, 7555–7565 (2022). https://doi.org/10.1007/s00330-022-08852-x

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