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Dual-source dual-energy CT in the evaluation of hepatic fractional extracellular space in cirrhosis



One of the main features of liver fibrosis is the expansion of the interstitial space. All water-soluble CT contrast agents remain confined in the vascular and interstitial space constituting the fractional extracellular space (fECS). Indirect measure of its expansion can be quantified during equilibrium phase with CT. The goal of this prospective study was to assess the feasibility of dual-energy CT (DECT) with iodine quantification at equilibrium phase in the evaluation of significant fibrosis or cirrhosis.


Thirty-eight cirrhotic patients (according to Child–Pugh and MELD scores), scheduled for liver CT, were enrolled in the study group. Twenty-four patients undergoing CT urography with a 10-min excretory phase were included in the control group. fECS was calculated as the ratio of the iodine concentration of liver parenchyma to that of the aorta, multiplied by 1 minus hematocrit.


Final study and control group were, respectively, composed of 22 and 20 patients. Mean hepatic fECS value was statistically greater in study group (P < 0.05). Positive correlation was observed between hepatic fECS value and MELD score (r = 0.64, P < 0.05). Analysis of variance showed statistical differences between control group and the Child–Pugh grades and between Child–Pugh A and B patients and Child–Pugh C patients (P < 0.05). ROC curves analysis yielded an optimum fECS cutoff value of 26.3% for differentiation of control group and cirrhotic patients (AUC 0.88; 86% sensitivity, 85% specificity).


Dual-source DECT is a feasible, noninvasive method for the assessment of significant liver fibrosis or cirrhosis.

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Correspondence to Salvatore Silipigni.

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Conflict of interest

Antonio Bottari declares that he has no conflict of interest. Salvatore Silipigni declares that he has no conflict of interest. Maria Ludovica Carerj declares that she has no conflict of interest. Antonino Cattafi declares that he has no conflict of interest. Sergio Maimone declares that he has no conflict of interest. Maria Adele Marino declares that she has no conflict of interest. Silvio Mazziotti declares that he has no conflict of interest. Alessia Pitrone declares that she has no conflict of interest. Giovanni Squadrito declares that he has no conflict of interest. Giorgio Ascenti declares that he has no conflict of interest.

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This article does not contain any studies with animals performed by any of the authors. All procedures performed on human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bottari, A., Silipigni, S., Carerj, M.L. et al. Dual-source dual-energy CT in the evaluation of hepatic fractional extracellular space in cirrhosis. Radiol med 125, 7–14 (2020).

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  • Dual-source
  • Dual-energy CT
  • Iodine concentration—fractional extracellular space
  • Fibrosis—cirrhosis