Estimating liver cirrhosis severity with extracellular volume fraction by spectral CT

Purpose To investigate the diagnostic value of spectral CT in calculating extracellular volume fraction (ECV) for assessing the severity of liver cirrhosis. Methods In this retrospective study, 172 patients (127 liver cirrhosis patients and 45 controls),who underwent spectral CT liver enhancement scans, and were categorized based on the Child-Pugh classification. During the delayed phase, ECV values were derived from iodine density map. These ECV values were then compared across the control group and subclassified cirrhosis groups (Child-Pugh classes A, B, and C). Furthermore, a correlation analysis was performed to assess the relationship between ECV values and Child-Pugh scores in liver cirrhosis. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance of ECV values and MELD-Na in the Child-Pugh classification of liver cirrhosis. Results The ECV values were 25.49±3.15, 29.73±3.20, 35.64±3.15, and 45.30±5.16 for the control, Child-Pugh A, Child-Pugh B, and Child-Pugh C group, respectively, demonstrating significant intergroup differences (F=184.67 P<0.001). A strong positive correlation was observed between ECV and Child-Pugh liver function classification (r=0.791, P<0.001). The diagnostic performance of ECV for differentiating between Child-Pugh classes A and B (AUC: 0.901), B and C (AUC: 0.966) was higher compared to the MELD-Na score (AUC: 0.772 and 0.868) (P<0.05, respectively). Multivariate analyses showed that ECV was the factor independently associated with cirrhosis (OR=1.610, P<0.001). Conclusion ECV values measured using spectral CT can serve as a noninvasive biomarker for assessing the severity of liver cirrhosis.