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.	萬上, 黃子星, 宋彬. 肝硬變食管下段靜脈曲張的 CT 研究進展. 中國普外基礎與臨床雜志, 2019, 26(6): 742-747.
2.	李清, 謝雙雙, 侯文靜, 等. 五期增強 CT 掃描評估正常肝實質及肝硬化患者肝臟灌注特性的可行性研究. 放射學實踐, 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.	Talaki? 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.	容鵬飛, 馮智超, 郭睿, 等. CT 動脈增強分數評估肝硬化患者肝功能水平. 中南大學學報(醫學版), 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. 萬上, 黃子星, 宋彬. 肝硬變食管下段靜脈曲張的 CT 研究進展. 中國普外基礎與臨床雜志, 2019, 26(6): 742-747.
2. 李清, 謝雙雙, 侯文靜, 等. 五期增強 CT 掃描評估正常肝實質及肝硬化患者肝臟灌注特性的可行性研究. 放射學實踐, 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. Talaki? 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. 容鵬飛, 馮智超, 郭睿, 等. CT 動脈增強分數評估肝硬化患者肝功能水平. 中南大學學報(醫學版), 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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