Liver segmental volume and attenuation ratio (LSVAR) on portal venous CT scans improves the detection of clinically significant liver fibrosis compared to liver segmental volume ratio (LSVR)

V. C. Obmann,J. T. Heverhagen,A. T. Huber,A. Berzigotti,N. Mertineit,C. Marx,A. Christe,J. Hrycyk,L. Ebner,Ch. Gräni

doi:10.1007/s00261-020-02834-7

V. C. Obmann, J. T. Heverhagen + Show 8 more

Open Access

https://doi.org/10.1007/s00261-020-02834-7

Copy DOI

Journal: Abdominal imaging	Publication Date: Nov 6, 2020
Citations: 7	License type: open-access

Affiliation: University Hospital of Bern, University of Bern

Abstract

BackgroundThe aim of this proof-of-concept study was to show that the liver segmental volume and attenuation ratio (LSVAR) improves the detection of significant liver fibrosis on portal venous CT scans by adding the liver vein to cava attenuation (LVCA) to the liver segmental volume ratio (LSVR).Material and methodsPatients who underwent portal venous phase abdominal CT scans and MR elastography (reference standard) within 3 months between 02/2016 and 05/2017 were included. The LSVAR was calculated on portal venous CT scans as LSVR*LVCA, while the LSVR represented the volume ratio between Couinaud segments I-III and IV-VIII, and the LVCA represented the density of the liver veins compared to the density in the vena cava. The LSVAR and LSVR were compared between patients with and without significantly elevated liver stiffness (based on a cutoff value of 3.5 kPa) using the Mann–Whitney U test and ROC curve analysis.ResultsThe LSVR and LSVAR allowed significant differentiation between patients with (n = 19) and without (n = 122) significantly elevated liver stiffness (p < 0.001). However, the LSVAR showed a higher area under the curve (AUC = 0.96) than the LSVR (AUC = 0.74). The optimal cutoff value was 0.34 for the LSVR, which detected clinically increased liver stiffness with a sensitivity of 53% and a specificity of 88%. With a cutoff value of 0.67 for the LSVAR, the sensitivity increased to 95% while maintaining a specificity of 89%.ConclusionThe LSVAR improves the detection of significant liver fibrosis on portal venous CT scans compared to the LSVR.

Highlights

Detection of clinically significant liver fibrosis is of utmost importance in preventing disease progression and the development of hepatocellular carcinoma (HCC) [1]
Improved predictions of significant liver fibrosis were achieved on abdominal CT scans with the new liver imaging morphology and attenuation fibrosis score (LIMA-FS), which is a combination of the caudate–right lobe ratio (CRL-R) with a liver vein to cava attenuation (LVCA) score [13]
Since the LVCA is simple and easy to calculate, we hypothesized that the LVCA might increase the performance of the liver segmental volume ratio (LSVR) in detecting liver fibrosis

Summary

Introduction

Detection of clinically significant liver fibrosis is of utmost importance in preventing disease progression and the development of hepatocellular carcinoma (HCC) [1]. Several quantitative methods allow for the detection of advanced fibrosis on CT scans, such as the caudate–right lobe ratio (CRL-R) and liver vein diameters [5, 6], CT texture analysis [7, 8], liver surface nodularity [9, 10], splenic volume and liver segmental volume ratio (LSVR) [11, 12]. Improved predictions of significant liver fibrosis were achieved on abdominal CT scans with the new liver imaging morphology and attenuation fibrosis score (LIMA-FS), which is a combination of the CRL-R with a liver vein to cava attenuation (LVCA) score [13].

Methods

Results

Conclusion