Predicting Chronic Liver Disease Severity by Liver and Splenic Extracellular Volume Fraction Derived from spectral-CT

To evaluate the effectiveness of spectral-CT in assessing the severity of liver diseases in patients with chronic liver disease (CLD).

A total of 148 CLD patients who underwent spectral-CT were retrospectively recruited, including 40 non-advanced CLD (non-ACLD), 74 compensated ACLD (cACLD), and 34 decompensated ACLD (dACLD). Iodine concentrations in the liver and spleen were assessed on iodine (water) images during the equilibrium phase, which allowed for the calculation of liver and splenic extracellular volume fractions (ECV). We determined the total liver volume, liver segmental volume ratio, and splenic volume from portal phase images. Moreover, established non-invasive tests were also collected. Areas under receiver operating characteristic curve (AUCs) were employed to evaluate the diagnostic performance of CT parameters and non-invasive tests in predicting CLD severity. Additionally, we analyzed the correlations between CT parameters and non-invasive tests.

The spleen volume demonstrated the highest AUC (0.815, P<0.001) for distinguishing between non-ACLD and cALCD. Child-Pugh score exhibited the highest AUC (0.948, P<0.001) for distinguishing cALCD and dACLD. Splenic ECV exhibited the highest AUC (0.853, P<0.001) for distinguishing non-ALCD and ACLD. In contrast, the liver ECV showed strong correlations with the Fibrosis-4 Index (r=0.653, p<0.001) and the Aminotransferase-to-Platelet Ratio Index (r=0.607, p<0.001), while spleen ECV correlated more strongly with the Child-Pugh score (r=0.719, p<0.001) and the Albumin-Bilirubin Index (r=0.742, p<0.001).

Liver and splenic ECV can effectively reflect the dynamic progression of CLD and correlate well with non-invasive tests in these patients.

Spectral-CT liver and splenic ECV could serve as non-invasive imaging biomarkers for severity stratification.