Top

Insights into Imaging

Published in:

Open Access 01-12-2023 | Hepatitis B | Original Article

Dual-energy CT quantification of extracellular liver volume predicts short-term disease progression in patients with hepatitis B liver cirrhosis-acute decompensation

Authors: Yuan Xu, Yufeng Li, Shenglin Li, Shouxiao Xue, Jianli Liu

Published in: Insights into Imaging | Issue 1/2023

Abstract

Background

Liver cirrhosis-acute decompensation (LC-AD) has rapid short-term disease progression and difficult early risk stratification. The purpose is to develop and validate a model based on dual-energy CT quantification of extracellular liver volume (ECV_IC-liver) for predicting the occurrence of acute-on-chronic liver failure (ACLF) within 90 days in patients with hepatitis B (HBV) LC-AD.

Methods

The retrospective study included patients with HBV LC-AD who underwent dual-energy CT scans of the liver from January 2018 to March 2022 and were randomized to training group (215 patients) and validation group (92 patients). The primary outcome was the need for readmission within 90 days due to ACLF. Based on the training group data, independent risk factors for disease progression in clinical and dual-energy CT parameters were identified and modeled by logistic regression analysis. Based on the training and validation groups data, receiver operating characteristic (ROC) curves, calibration curves, and decision analysis curves (DCA) were used to verify the discrimination, calibration, and clinical validity of the nomogram.

Results

Chronic liver failure consortium-acute decompensation score (CLIF-C ADs) (p = 0.008) and ECV_IC-liver (p < 0.001) were independent risk factors for ACLF within 90 days. The AUC of the model combined ECV_IC-liver and CLIF-C ADs were 0.893 and 0.838 in the training and validation groups, respectively. The calibration curves show good agreement between predicted and actual risks. The DCA indicates that the model has good clinical application.

Conclusion

The model combined ECV_IC-liver and CLIF-C ADs can early predict the occurrence of ACLF within 90 days in HBV LC-AD patients.

Available only for authorised users

D’Amico G, Bernardi M, Angeli P (2022) Towards a new definition of decompensated cirrhosis. J Hepatol 76:202–207. https://doi.org/10.1016/j.jhep.2021.06.018CrossRefPubMed

Trebicka J, Fernandez J, Papp M et al (2020) The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol 73:842–854. https://doi.org/10.1016/j.jhep.2020.06.013CrossRefPubMed

Moreau R, Gao B, Papp M et al (2021) Acute-on-chronic liver failure: a distinct clinical syndrome. J Hepatol 75:27–35. https://doi.org/10.1016/j.jhep.2020.11.047CrossRef

Sarin SK, Choudhury A, Sharma MK et al (2019) Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hep Intl 13:353–390. https://doi.org/10.1007/s12072-019-09946-3CrossRef

Arroyo V, Moreau R (2017) Diagnosis and prognosis of acute on chronic liver failure (ACLF) in cirrhosis. J Hepatol 66:451–453. https://doi.org/10.1016/j.jhep.2016.10.012CrossRefPubMed

Wiesner R, Edwards E, Freeman R et al (2003) Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 124:91–96. https://doi.org/10.1053/gast.2003.50016CrossRefPubMed

Hernaez R, Patel A, Jackson LK et al (2020) Considerations for prognosis, goals of care, and specialty palliative care for hospitalized patients with acute-on-chronic liver failure. Hepatology 72:1109–1116. https://doi.org/10.1002/hep.31316CrossRefPubMed

Jalan R, Pavesi M, Saliba F et al (2015) The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol 62:831–840. https://doi.org/10.1016/j.jhep.2014.11.012CrossRefPubMed

Xiao KY, Hubbard RA, Kaplan DE et al (2020) Models for acute on chronic liver failure development and mortality in a veterans affairs cohort. Hep Intl 14:587–596. https://doi.org/10.1007/s12072-020-10060-yCrossRef

10.

Ren Y, Liu L, Li Y et al (2018) Development and validation of a scoring system to predict progression to acute-on-chronic liver failure in patients with acute exacerbation of chronic hepatitis B. Hepatol Res 48:692–700. https://doi.org/10.1111/hepr.13062CrossRefPubMed

11.

Antunes AG, Teixeira C, Vaz AM et al (2017) Comparison of the prognostic value of Chronic Liver Failure Consortium scores and traditional models for predicting mortality in patients with cirrhosis. Gastroenterol Hepatol 40:276–285. https://doi.org/10.1016/j.gastrohep.2017.01.001CrossRefPubMed

12.

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.0000000000000123CrossRefPubMed

13.

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.2016.10.003CrossRefPubMed

14.

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.14141435CrossRefPubMed

15.

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.12112452CrossRefPubMedPubMedCentral

16.

Tsurusaki M, Sofue K, Hori M et al (2021) Dual-energy computed tomography of the liver: uses in clinical practices and applications. Diagnostics (Basel) 11:161. https://doi.org/10.3390/diagnostics11020161CrossRefPubMed

17.

Nagayama Y, Kato Y, Inoue T et al (2021) Liver fibrosis assessment with multiphasic dual-energy CT: diagnostic performance of iodine uptake parameters. Eur Radiol 31:5779–5790. https://doi.org/10.1007/s00330-021-07706-2CrossRefPubMed

18.

Bak S, Kim JE, Bae K et al (2020) Quantification of liver extracellular volume using dual-energy CT: utility for prediction of liver-related events in cirrhosis. Eur Radiol 30:5317–5326. https://doi.org/10.1007/s00330-020-06876-9CrossRefPubMed

19.

Sivapornpan N, Ratana-Amornpin S, Siramolpiwat S (2022) Hemostatic parameters predict 90-day mortality in hospitalized cirrhotic patients with acute decompensation: a prospective cohort study. Blood Coagul Fibrinolysis Int J Haemostasis Thrombosis 33:176–183. https://doi.org/10.1097/MBC.0000000000001124CrossRef

20.

Kessner R, Große Hokamp N, Ciancibello L et al (2019) Renal cystic lesions characterization using spectral detector CT (SDCT): Added value of spectral results. Br J Radiol 92:20180915. https://doi.org/10.1259/bjr.20180915CrossRefPubMedPubMedCentral

21.

Yoon JH, Lee JM, Kim JH et al (2021) Hepatic fibrosis grading with extracellular volume fraction from iodine mapping in spectral liver CT. Eur J Radiol 137:109604. https://doi.org/10.1016/j.ejrad.2021.109604CrossRefPubMed

22.

Trebicka J, Amoros A, Pitarch C et al (2019) Addressing profiles of systemic inflammation across the different clinical phenotypes of acutely decompensated cirrhosis. Front Immunol 10:476. https://doi.org/10.3389/fimmu.2019.00476CrossRefPubMedPubMedCentral

23.

Jalan R, D’Amico G, Trebicka J et al (2021) New clinical and pathophysiological perspectives defining the trajectory of cirrhosis. J Hepatol 75:S14–S26. https://doi.org/10.1016/j.jhep.2021.01.018CrossRefPubMed

24.

Abraldes JG, Tarantino I, Turnes J et al (2003) Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 37:902–908. https://doi.org/10.1053/jhep.2003.50133CrossRefPubMed

25.

Isaak A, Praktiknjo M, Jansen C et al (2020) Myocardial fibrosis and inflammation in liver cirrhosis: MRI study of the liver-heart axis. Radiology 297:51–61. https://doi.org/10.1148/radiol.2020201057CrossRefPubMed

26.

Mesropyan N, Isaak A, Faron A et al (2021) Magnetic resonance parametric mapping of the spleen for non-invasive assessment of portal hypertension. Eur Radiol 31:85–93. https://doi.org/10.1007/s00330-020-07080-5CrossRefPubMed

27.

Baldin C, Piedade J, Guimarães L et al (2021) CLIF-C AD score predicts development of acute decompensations and survival in hospitalized cirrhotic patients. Dig Dis Sci 66:4525–4535. https://doi.org/10.1007/s10620-020-06791-5CrossRefPubMed

28.

Lurz JA, Luecke C, Lang D et al (2018) CMR-Derived extracellular volume fraction as a marker for myocardial fibrosis: the importance of coexisting myocardial inflammation. JACC Cardiovasc Imaging 11:38–45. https://doi.org/10.1016/j.jcmg.2017.01.025CrossRefPubMed

29.

Kokubo R, Saito K, Yamada T et al (2022) Comparison of liver fibrosis and function indices with extracellular volume using dual-energy CT: a retrospective study. Curr Med Imaging 18:1180–1185. https://doi.org/10.2174/1573405618666220407100237CrossRefPubMed

30.

Luetkens JA, Klein S, Träber F et al (2018) Quantification of liver fibrosis at T1 and T2 mapping with extracellular volume fraction MRI: preclinical results. Radiology 288:748–754. https://doi.org/10.1148/radiol.2018180051CrossRefPubMed

31.

Tani T, Sato K, Sakamoto K et al (2021) Importance of extracellular volume fraction of the spleen as a predictive biomarker for high-risk esophago-gastric varices in patients with chronic liver diseases: a preliminary report. Eur J Radiol 143:109924. https://doi.org/10.1016/j.ejrad.2021.109924CrossRefPubMed

32.

Emoto T, Oda S, Kidoh M et al (2021) Myocardial extracellular volume quantification using cardiac computed tomography: a comparison of the dual-energy iodine method and the standard subtraction method. Acad Radiol 28:e119–e126. https://doi.org/10.1016/j.acra.2020.03.019CrossRefPubMed

33.

Mesropyan N, Kupczyk PA, Dold L et al (2022) Assessment of liver cirrhosis severity with extracellular volume fraction MRI. Sci Rep 12:9422. https://doi.org/10.1038/s41598-022-13340-9CrossRefPubMedPubMedCentral

Title: Dual-energy CT quantification of extracellular liver volume predicts short-term disease progression in patients with hepatitis B liver cirrhosis-acute decompensation
Authors: Yuan Xu
Yufeng Li
Shenglin Li
Shouxiao Xue
Jianli Liu
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Hepatitis B
Liver Cirrhosis
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01393-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dual-energy CT quantification of extracellular liver volume predicts short-term disease progression in patients with hepatitis B liver cirrhosis-acute decompensation

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Right and left ventricular blood pool T2 ratio on cardiac magnetic resonance imaging correlates with hemodynamics in patients with pulmonary hypertension

Mucosal healing assessment in Crohn’s disease with normalized iodine concentration from dual-energy CT enterography: comparison with endoscopy

Comparative study of the sensitivity of ultra-high-resolution CT and high-resolution CT in the diagnosis of isolated fenestral otosclerosis

Development of a simplified model and nomogram in preoperative diagnosis of pediatric chronic cholangitis with pancreaticobiliary maljunction using clinical variables and MRI radiomics

Classification of nasal polyps and inverted papillomas using CT-based radiomics

Myocardial extracellular volume quantification with computed tomography—current status and future outlook