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Dual-energy CT quantification of fractional extracellular space in cirrhotic patients: comparison between early and delayed equilibrium phases and correlation with oesophageal varices

  • Abdominal Radiology
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Abstract

Objective

Fractional extracellular space has been validated as a marker of hepatic fibrotic in cirrhotic patients at CT-scan as well as on dual-energy CT, which takes advantage from iodine uptake. Since no consensus still exists between equilibrium phases performed at 3 or 10 min, the first aim of this work is to evaluate performances at the two different time points. Moreover, correlation between fractional extracellular space and oesophageal varices, directly related to liver fibrosis, has been assessed.

Materials and methods

Dual-Energy equilibrium phases at 3 and 10 min were performed within a follow-up CT-protocol scan in cirrhotic patients. Oesophageal varices were endoscopically assessed according to their size. At the two different time points, correlation between iodine density of the right and left liver lobes and correlation between the fractional extracellular space values were assessed. Correlation between fractional extracellular space and endoscopic grade of oesophageal varices was calculated.

Results

No statistical differences were found between the iodine density values from the two liver lobes at the two time points (p = 0.8 at 3′; p = 0.5 at 10′). No statistical difference about fractional extracellular space estimation was found between the two time points (p = 0.17). Correlation between fractional extracellular space values and oesophageal varices was moderate (ρ = 0.45, IC 0.08–0.71, p < 0.05).

Conclusion

Fractional extracellular space assessed on dual-energy CT at equilibrium phases with different timing was substantially similar. The moderate correlation found between fractional extracellular space and endoscopic grade of oesophageal varices confirms that CT-scan is not currently reliable as endoscopy.

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References

  1. Pinzani M, Rombouts K (2004) Liver fibrosis: from the bench to clinical targets. Dig Liver Dis 36:231–242. https://doi.org/10.1016/j.dld.2004.01.003

    Article  CAS  PubMed  Google Scholar 

  2. Friedman SL (2003) Liver fibrosis—from bench to bedside. J Hepatol 38:38–53. https://doi.org/10.1016/S0168-8278(02)00429-4

    Article  Google Scholar 

  3. Varenika V, Fu Y, Maher JJ et al (2013) Hepatic fibrosis: evaluation with semiquantitative contrast-enhanced CT. Radiology 266:151–158. https://doi.org/10.1148/radiol.12112452

    Article  PubMed  PubMed Central  Google Scholar 

  4. Villeneuve JP, Dagenais M, Huet PM et al (1996) The hepatic microcirculation in the isolated perfused human liver. Hepatol Baltim Md 23:24–31. https://doi.org/10.1002/hep.510230104

    Article  CAS  Google Scholar 

  5. Sahin S, Rowland M (2000) Estimation of aqueous distributional spaces in the dual perfused rat liver. J Physiol 528:199–207. https://doi.org/10.1111/j.1469-7793.2000.00199.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Zissen MH, Wang ZJ, Yee J et al (2013) Contrast-enhanced CT quantification of the hepatic fractional extracellular space: correlation with diffuse liver disease severity. AJR 201:1204–1210. https://doi.org/10.2214/AJR.12.10039

    Article  PubMed  Google Scholar 

  7. Bandula S, Punwani S, Rosenberg WM et al (2015) Equilibrium contrast-enhanced CT imaging to evaluate hepatic fibrosis: initial validation by comparison with histopathologic sampling. Radiology 275:136–143. https://doi.org/10.1148/radiol.14141435

    Article  PubMed  Google Scholar 

  8. Yoon JH, Lee JM, Klotz E et al (2015) Estimation of hepatic extracellular volume fraction using multiphasic liver computed tomography for hepatic fibrosis grading. Invest Radiol 50:290–296. https://doi.org/10.1097/RLI.0000000000000123

    Article  PubMed  Google Scholar 

  9. Guo SL, Su LN, Zhai YN et al (2017) The clinical value of hepatic extracellular volume fraction using routine multiphasic contrast-enhanced liver CT for staging liver fibrosis. Clin Radiol 72:242–246. https://doi.org/10.1016/j.crad.2016.10.003

    Article  CAS  PubMed  Google Scholar 

  10. Ascenti G, Sofia C, Mazziotti S et al (2016) Dual-energy CT with iodine quantification in distinguishing between bland and neoplastic portal vein thrombosis in patients with hepatocellular carcinoma. Clin Radiol 71:938.e1-938.e9. https://doi.org/10.1016/j.crad.2016.05.002

    Article  CAS  Google Scholar 

  11. Ascenti G, Mileto A, Krauss B et al (2013) Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements. Eur Radiol 23:2288–2295. https://doi.org/10.1007/s00330-013-2811-4

    Article  PubMed  Google Scholar 

  12. Ascenti G, Mazziotti S, Mileto A et al (2012) Dual-source dual-energy CT evaluation of complex cystic renal masses. Am J Roentgenol 199:1026–1034. https://doi.org/10.2214/AJR.11.7711

    Article  Google Scholar 

  13. Marino MA, Silipigni S, Barbaro U et al (2017) Dual energy CT scanning in evaluation of the urinary tract. Curr Radiol Rep 5:46. https://doi.org/10.1007/s40134-017-0243-7

    Article  Google Scholar 

  14. Sofue K, Tsurusaki M, Mileto A et al (2018) Dual-energy computed tomography for non-invasive staging of liver fibrosis: accuracy of iodine density measurements from contrast-enhanced data: staging of liver fibrosis in dual-energy CT. Hepatol Res. https://doi.org/10.1111/hepr.13205

    Article  PubMed  Google Scholar 

  15. Bottari A, Silipigni S, Carerj ML et al (2019) Dual-source dual-energy CT in the evaluation of hepatic fractional extracellular space in cirrhosis. Radiol Med. https://doi.org/10.1007/s11547-019-01089-7

    Article  PubMed  Google Scholar 

  16. Tsoris A, Marlar CA (2019) Use of the Child Pugh score in liver disease. In: StatPearls. StatPearls Publishing, Treasure Island (FL)

  17. Hashizume M, Kitano S, Yamaga H et al (1990) Endoscopic classification of gastric varices. Gastrointest Endosc 36:276–280. https://doi.org/10.1016/S0016-5107(90)71023-1

    Article  CAS  PubMed  Google Scholar 

  18. Abby Philips C, Sahney A (2016) Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place. Gastroenterol Rep 4:186–195

    Article  Google Scholar 

  19. de Oliveira AC (2017) Short article: noninvasive assessment of portal hypertension and detection of esophageal varices in cirrhosis. Eur J Gastroenterol Hepatol 29:531–534. https://doi.org/10.1097/MEG.0000000000000830

    Article  PubMed  Google Scholar 

  20. Garcia-Tsao G (2004) Portal hypertension. Curr Opin Gastroenterol 20:254–263. https://doi.org/10.1097/00001574-200405000-00010

    Article  PubMed  Google Scholar 

  21. Reiberger T, Ferlitsch A, Payer BA et al (2012) Non-selective β-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis. J Gastroenterol 47:561–568. https://doi.org/10.1007/s00535-011-0517-4

    Article  CAS  PubMed  Google Scholar 

  22. Bauer RW, Kramer S, Renker M et al (2011) Dose and image quality at CT pulmonary angiography—comparison of first and second generation dual-energy CT and 64-slice CT. Eur Radiol 21:2139–2147. https://doi.org/10.1007/s00330-011-2162-y

    Article  PubMed  Google Scholar 

  23. Marin D, Ramirez-Giraldo JC, Gupta S et al (2016) Effect of a noise-optimized second-generation monoenergetic algorithm on image and conspicuity of hypervascular liver tumors: an in vitro and in vivo study. Am J Roentgenol 206:1222–1232. https://doi.org/10.2214/AJR.15.15512

    Article  Google Scholar 

  24. Berzigotti A, Bosch J (2018) Diagnostic methods for cirrhosis and portal hypertension. Springer International Publishing, Cham

    Book  Google Scholar 

Download references

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Authors and Affiliations

  1. Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100, Messina, Italy

    Giuseppe Cicero, Silvio Mazziotti, Salvatore Silipigni, Alfredo Blandino, Stefano Pergolizzi, Tommaso D’Angelo, Alberto Stagno & Giorgio Ascenti

  2. Department of Radiology, “Sapienza” University of Rome, Rome, Italy

    Vito Cantisani

  3. Division of Clinical and Molecular Hepatology, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100, Messina, Italy

    Sergio Maimone & Giovanni Squadrito

Authors
  1. Giuseppe Cicero
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  2. Silvio Mazziotti
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  3. Salvatore Silipigni
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  4. Alfredo Blandino
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  6. Stefano Pergolizzi
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  7. Tommaso D’Angelo
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  8. Alberto Stagno
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  9. Sergio Maimone
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  11. Giorgio Ascenti
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Correspondence to Giuseppe Cicero.

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This work was 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.

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Cicero, G., Mazziotti, S., Silipigni, S. et al. Dual-energy CT quantification of fractional extracellular space in cirrhotic patients: comparison between early and delayed equilibrium phases and correlation with oesophageal varices. Radiol med 126, 761–767 (2021). https://doi.org/10.1007/s11547-021-01341-z

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  • DOI: https://doi.org/10.1007/s11547-021-01341-z

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