Value of CT arterial enhancement fraction based on histogram analysis in severity of liver cirrhosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Shulin , WANG Zhi , WANG Yimin , TANG Fang , LI Hongxia , ZHANG Zhi ,  HU Fubi

Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, P. R. China;

Corresponding author：

HU Fubi, Email: yingxianghu_cmc@163.com

Keywords：

liver cirrhosis; perfusion imaging; arterial enhancement fraction; histogram analysis

DOI：

10.7507/1007-9424.201911110

Video：

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Objective To investigate the diagnostic performance of parameters of arterial enhancement fraction (AEF) based on enhanced CT with histogram analysis in the severity of liver cirrhosis.Methods The patients with liver cirrhosis clinically confirmed and met the inclusion criteria were included from January 2016 to December 2018 in the First Affiliated Hospital of Chengdu Medical College, then them were divided into grade A, B, and C according to the Child-Pugh score. Meanwhile, the patients without liver disease were selected as the control group. All patients underwent the upper abdomen enhanced CT scan with three-phase and the biochemical examination of liver function. The parameters of AEF histogram were obtained by using the CT Kinetics software, and the aspartic aminotransferase and platelet ratio index (APRI) was calculated. The differences of parameters of AEF histogram and APRI among these patients with liver cirrhosis and without liver disease were analyzed. The diagnostic performance was evaluated by using the area under curve (AUC) of receivers operating characteristic curve.Results Eighty-five patients with liver cirrhosis were included in this study, including 25, 41, and 19 patients with grade A, B, and C of Child-Pugh score, respectively, and there were 20 patients in the control group. The consistencies in measuring the parameters of AEF histogram twice for the same observer and between the two observers were good (intraclass correlation coefficient was 0.938 and 0.907, respectively). The mean, median, and kurtosis of AEF histogram and the APRI among the grade A, B, C of Child-Pugh score, and control group had significant differences (all P<0.001) and these indexes were positively correlated with the severity of liver cirrhosis (r_s=0.811, P<0.001; r_s=0.827, P<0.001; r_s=0.731, P<0.001; r_s=0.711, P<0.001). The AUC of the mean, median, kurtosis, and APRI in diagnosing grade A of liver cirrhosis was 0.829, 0.841, 0.747, and 0.718, respectively; which in diagnosing grade B of liver cirrhosis was 0.847, 0.734, 0.704, and 0.736, respectively; in diagnosing grade C of liver cirrhosis was 0.646, 0.825, 0.782, and 0.853, respectively.Conclusion The mean and median of AEF histogram parameters based on enhanced CT with three-phase and serological APRI are useful in diagnosis of grage A, B, and C of liver cirrhosis, respectively.

Citation： LIU Shulin, WANG Zhi, WANG Yimin, TANG Fang, LI Hongxia, ZHANG Zhi, HU Fubi. Value of CT arterial enhancement fraction based on histogram analysis in severity of liver cirrhosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(1): 97-102. doi: 10.7507/1007-9424.201911110 Copy

1.	万上, 黄子星, 宋彬. 肝硬变食管下段静脉曲张的 CT 研究进展. 中国普外基础与临床杂志, 2019, 26(6): 742-747.
2.	李清, 谢双双, 侯文静, 等. 五期增强 CT 扫描评估正常肝实质及肝硬化患者肝脏灌注特性的可行性研究. 放射学实践, 2018, 33(1): 40-45.
3.	Lee DH, Lee JM, Klotz E, et al. Multphasic dynamic computed tomography evaluation of liver tissue perfusion characteristic using the dual maximum slope model in patients with cirrhosis and hepatocellular carcinoma: a feasibility study. Invest Rdiol, 2016, 51(7): 430-434.
4.	Ronot M, Leporq B, Van Beers BE, et al. CT and MR perfusion techniques to assess diffuse liver disease. Abdom Radiol (NY), 2019.
5.	Talakić E, Schaffellner S, Kniepeiss D, et al. CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension? Eur Radiol, 2017, 27(10): 4173-4180.
6.	Ippolito D, Pecorelli A, Querques G, et al. Dynamic computed tomography perfusion imaging: Complementary diagnostic tool in hepatocellular carcinoma assessment from diagnosis to treatment follow-up. Acad Radiol, 2019, 26(12): 1675-1685.
7.	Negi N, Yoshikawa T, Ohno Y, et al. Hepatic CT perfusion measurements: a feasibility study for radiation dose reduction using new image reconstruction method. Eur J Radiol, 2012, 81(11): 3048-3054.
8.	Kartalis N, Brehmer K, Loizou L. Multi-detector CT: Liver protocol and recent developments. Eur J Radiol, 2017, 97: 101-109.
9.	Kang SE, Lee JM, Klotz E, et al. Quantitative color mapping of the arterial enhancement fraction in patients with diffuse liver disease. AJR Am J Roentgenol, 2011, 197(4): 876-883.
10.	容鹏飞, 冯智超, 郭睿, 等. CT 动脉增强分数评估肝硬化患者肝功能水平. 中南大学学报(医学版), 2019, 44(5): 469-476.
11.	Bonekamp D, Bonekamp S, Geiger B, et al. An elevated arterial enhancement fraction is associated with clinical and imaging indices of liver fibrosis and cirrhosis. J Comput Assist Tomogr, 2012, 36(6): 681-689.
12.	Petitclerc L, Sebastiani G, Gilbert G, et al. Liver fibrosis: Review of current imaging and MRI quantification techniques. J Magn Reson Imaging, 2017, 45(5): 1276-1295.
13.	Maksan SM, Ryschich E, Ulger Z, et al. Disturbance of hepatic and intestinal microcirculation in experimental liver cirrhosis. World J Gastroenterol, 2005, 11(6): 846-849.
14.	Shiha G, Ibrahim A, Helmy A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int, 2017, 11(1): 1-30.
15.	Lubner MG, Smith AD, Sandrasegaran K, et al. CT texture analysis: definitions, applications, biologic correlates, and challenges. Radiographics, 2017, 37(5): 1483-1503.
16.	Wong VW, Adams LA, de Lédinghen V, et al. Noninvasive biomarkers in NAFLD and NASH—current progress and future promise. Nat Rev Gastroenterol Hepatol, 2018, 15(8): 461-478.
17.	Raman SP, Schroeder JL, Huang P, et al. Preliminary data using computed tomography texture analysis for the classification of hypervascular liver lesions: generation of a predictive model on the basis of quantitative spatial frequency measurements—a work in progress. J Comput Assist Tomogr, 2015, 39(3): 383-395.

1. 万上, 黄子星, 宋彬. 肝硬变食管下段静脉曲张的 CT 研究进展. 中国普外基础与临床杂志, 2019, 26(6): 742-747.
2. 李清, 谢双双, 侯文静, 等. 五期增强 CT 扫描评估正常肝实质及肝硬化患者肝脏灌注特性的可行性研究. 放射学实践, 2018, 33(1): 40-45.
3. Lee DH, Lee JM, Klotz E, et al. Multphasic dynamic computed tomography evaluation of liver tissue perfusion characteristic using the dual maximum slope model in patients with cirrhosis and hepatocellular carcinoma: a feasibility study. Invest Rdiol, 2016, 51(7): 430-434.
4. Ronot M, Leporq B, Van Beers BE, et al. CT and MR perfusion techniques to assess diffuse liver disease. Abdom Radiol (NY), 2019.
5. Talakić E, Schaffellner S, Kniepeiss D, et al. CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension? Eur Radiol, 2017, 27(10): 4173-4180.
6. Ippolito D, Pecorelli A, Querques G, et al. Dynamic computed tomography perfusion imaging: Complementary diagnostic tool in hepatocellular carcinoma assessment from diagnosis to treatment follow-up. Acad Radiol, 2019, 26(12): 1675-1685.
7. Negi N, Yoshikawa T, Ohno Y, et al. Hepatic CT perfusion measurements: a feasibility study for radiation dose reduction using new image reconstruction method. Eur J Radiol, 2012, 81(11): 3048-3054.
8. Kartalis N, Brehmer K, Loizou L. Multi-detector CT: Liver protocol and recent developments. Eur J Radiol, 2017, 97: 101-109.
9. Kang SE, Lee JM, Klotz E, et al. Quantitative color mapping of the arterial enhancement fraction in patients with diffuse liver disease. AJR Am J Roentgenol, 2011, 197(4): 876-883.
10. 容鹏飞, 冯智超, 郭睿, 等. CT 动脉增强分数评估肝硬化患者肝功能水平. 中南大学学报(医学版), 2019, 44(5): 469-476.
11. Bonekamp D, Bonekamp S, Geiger B, et al. An elevated arterial enhancement fraction is associated with clinical and imaging indices of liver fibrosis and cirrhosis. J Comput Assist Tomogr, 2012, 36(6): 681-689.
12. Petitclerc L, Sebastiani G, Gilbert G, et al. Liver fibrosis: Review of current imaging and MRI quantification techniques. J Magn Reson Imaging, 2017, 45(5): 1276-1295.
13. Maksan SM, Ryschich E, Ulger Z, et al. Disturbance of hepatic and intestinal microcirculation in experimental liver cirrhosis. World J Gastroenterol, 2005, 11(6): 846-849.
14. Shiha G, Ibrahim A, Helmy A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int, 2017, 11(1): 1-30.
15. Lubner MG, Smith AD, Sandrasegaran K, et al. CT texture analysis: definitions, applications, biologic correlates, and challenges. Radiographics, 2017, 37(5): 1483-1503.
16. Wong VW, Adams LA, de Lédinghen V, et al. Noninvasive biomarkers in NAFLD and NASH—current progress and future promise. Nat Rev Gastroenterol Hepatol, 2018, 15(8): 461-478.
17. Raman SP, Schroeder JL, Huang P, et al. Preliminary data using computed tomography texture analysis for the classification of hypervascular liver lesions: generation of a predictive model on the basis of quantitative spatial frequency measurements—a work in progress. J Comput Assist Tomogr, 2015, 39(3): 383-395.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of CT arterial enhancement fraction based on histogram analysis in severity of liver cirrhosis

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