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Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex:
Benjamin Wildman-Tobriner1, Michael S Enslow1, Rendon C Nelson1
1Department of Radiology, Duke University Medical Center, Durham, NC.
Insights
Increased liver heterogeneity on CT scans may indicate hypoperfusion shock complex (HSC). This objective marker shows promise, unlike overall liver attenuation, which is a poor indicator of HSC.
Area of Science:
- Radiology
- Medical Imaging
- Trauma Imaging
Background:
- Hypoperfusion shock complex (HSC) is a critical condition.
- Objective markers for diagnosing HSC are valuable in trauma care.
- Computed tomography (CT) is a key imaging modality in trauma assessment.
Purpose of the Study:
- To determine if hepatic heterogeneity or liver attenuation on CT can predict the presence of HSC.
- To evaluate the diagnostic performance of these CT-derived liver metrics for HSC.
Main Methods:
- Retrospective study comparing 73 patients with HSC (cases) and 100 controls with negative trauma CT scans.
- Liver heterogeneity quantified by measuring density differences in Hounsfield units (HU) across ROIs.
- Liver attenuation measured by the mean HU from randomly placed ROIs.
Main Results:
- Median hepatic heterogeneity was significantly higher in the HSC group (16.8 HU) compared to controls (9.0 HU) (P < 0.001).
- A heterogeneity threshold of 30 HU demonstrated 100% specificity for HSC.
- Median hepatic attenuation did not significantly differ between groups (AUC = 0.56).
Conclusions:
- Increased hepatic heterogeneity on CT is a potential objective imaging biomarker for HSC.
- Hepatic heterogeneity shows comparable performance to other established HSC indicators.
- Overall liver hypoattenuation on CT is not a reliable predictor of HSC.
Objective:
When objectively measured on computed tomography (CT), does hepatic heterogeneity or overall liver attenuation predict the presence of shock?
Methods:
This retrospective study included 73 patients (mean age 33 years) with the hypoperfusion shock complex (HSC) on CT (cases) and 100 patients (mean age 43 years) with negative trauma CT scans (controls). Liver heterogeneity was calculated by using consistently sized regions of interest (ROIs) to measure the 2 highest and the 2 lowest areas of hepatic density (in Hounsfield units [HU]). The difference between the means of the 2 highest and 2 lowest ROIs was considered the heterogeneity. Attenuation was calculated using the mean of 3 randomly placed ROIs. Both heterogeneity and attenuation were then compared between cases and controls.
Results:
Median hepatic heterogeneity was 16.8 HU (IQR: 10.7-23.4) for the HSC group and 9.0 HU (IQR: 7.0-10.4) for the controls (P < 0.001). The area under the curve was 0.79, and a threshold of 30 HU yielded a specificity of 100%. Median hepatic attenuation was not significantly different between the HSC and the control groups, with an area under the curve of 0.56.
Conclusions:
Increased hepatic heterogeneity may represent an objective marker of the HSC that performs in a similar manner to other established signs. By comparison, overall hepatic hypoattenuation is a poor indicator of the HSC.
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