Predicting of hepatic steatosis in living liver donor via CT liver attenuation index (LAI) and fibroscan controlled attenuation parameter (CAP) correlation with biopsy result

Abstract

BackgroundThe most prevalent persistent parenchymatous liver alterations in healthy individuals are thought to be hepatic steatosis. The liver biopsy is the most crucial procedure for the identification and measurement of hepatic steatosis. By identifying the liver attenuation index (LAI) at CT image with fibroscan controlled attenuation parameter (CAP), hepatic steatosis can be evaluated without the risk of liver resection.ObjectiveUsing liver biopsy histological analysis as a reference standard, to examine the precision of the CT liver attenuation index (LAI) and fibroscan controlled attenuation parameter (CAP) for quantitative evaluation of macrovesicular steatosis in living related liver donors.MethodsIn this cross-sectional study, comparing the CT liver attenuation index & fibroscan controlled attenuation parameter with liver biopsy result for the detection of the steatosis in subject's candidate for liver living donors, 50 subjects were conducted at Ain Shams Specialized Hospital and other private hospitals over about 2 years.ResultsOur study reported that liver attenuation index of 9 is the cutoff value in post-contrast CT images with sensitivity 100% and specificity 80% that make it a very good method to exclude donor to have steatosis ≥ 15%, which mean that if donor had LAI index < 9, we can safely do proceed do liver biopsy. Our study reported that CAP measurement had an AUROC OF 0.780, for detecting steatosis ≥ 15%, with sensitivity is only 60% with specificity as CT LAI of 80%, our results consider low compared to other studies, that could be due to small number of donors in our study with steatosis ≥ 15% (five cases from 50 donors) unlike the other studies.ConclusionWhen used to estimate the amount of liver fat in liver donors, the examined CAP and CT indices worked equally. But according to multivariate analysis, the only factor strongly linked with hepatic steatosis in a living donors was the CT LAI index. We contend that the combination of CT LS attenuation index and CAP allows for the detection of the degree of hepatic steatosis and can be used as an option to liver biopsy, reserving liver biopsy for those with positive steatosis donors.