CT predicts liver fibrosis: Prospective evaluation of morphology- and attenuation-based quantitative scores in routine portal venous abdominal scans

• Published in: PloS one Vol. 13; no. 7; p. e0199611
• Main Authors: Obmann, Verena C, Mertineit, Nando, Berzigotti, Annalisa, Marx, Christina, Ebner, Lukas, Kreis, Roland, Vermathen, Peter, Heverhagen, Johannes T, Christe, Andreas, Huber, Adrian T
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.07.2018; Public Library of Science (PLoS)
• Subjects: Abdomen; Adult; Aged; Aging (Biology); Attenuation; Bile; Biology and Life Sciences; Biomedical research; CAT scans; Computed tomography; Control; Cross-Sectional Studies; Female; Fibrosis; Gastroenterology; Health care costs; Hepatitis; Hepatocellular carcinoma; Hepatology; Histology; Humans; Hypertension, Portal - diagnostic imaging; Hypertension, Portal - etiology; Image Processing, Computer-Assisted; Informed consent; Laboratories; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Liver diseases; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Mathematical analysis; Medical imaging; Medicine and Health Sciences; Metastases; Methods; Middle Aged; Morphology; Obesity; Patients; Pediatrics; Population; Portal Vein - diagnostic imaging; Portal Vein - physiopathology; Prevention; Prognosis; Research and Analysis Methods; Risk Factors; ROC Curve; Sensitivity analysis; Shear modulus; Spectrum analysis; Surgery; Systematic review; Tomography, X-Ray Computed - methods; Ultrasonic imaging; Veins & arteries; Veins (geology); Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0199611

Our aim was to prospectively determine whether quantitative computed tomography (CT) scores, consisting of simplified indices for liver remodeling and attenuation, may predict liver fibrosis in abdominal CT scans. This cross-sectional, prospective study was approved by the local IRB (Kantonale Ethikkommission Bern). Written informed consent was given from all patients undergoing study-MR exams. Between 02/16 and 05/17, four different liver fibrosis scores (CRL-R = caudate-right-lobe ratio, LIMV-, LIMA- and LIMVA-fibrosis score, with "LIM" for liver imaging morphology, "V" for liver vein diameter and "A" for attenuation) were calculated in 1534 consecutive abdominal CT scans, excluding patients with prior liver surgery and liver metastasis. Patients were invited to undergo magnetic resonance (MR) elastography as the non-invasive gold standard to evaluate liver fibrosis. MR elastography shear modulus ≥2.8 kPa was defined as beginning liver fibrosis, while ≥3.5 kPa was defined as significant liver fibrosis (which would correspond to fibrosis stage F2 or higher in histology). Cutoff values, sensitivities and specificities obtained from the receiver operating characteristics (ROC) analysis were then calculated in 141 patients who followed the invitation for MR elastography. To mitigate selection bias, prevalence was estimated in the screened total population (n = 1534) by applying the cutoff values with sensitivities and specificities calculated in the MR elastography sub-group. Positive predictive values (PPV) and negative predictive values (NPV) were then calculated. Fibrosis scores including liver vein attenuation LIMA-FS and LIMVA-FS showed higher areas under the ROC curves (0.96-0.97) than CRL-R (0.82) to detect significant liver fibrosis, while LIMV-FS showed good performance as well (0.92). The prevalence-corrected PPV were 29% for CRL-R, 70% for LIMV-FS, 76% for LIMA-FS and 82% for LIMVA-FS. CT fibrosis scores, notably LIMA-FS and LIMVA-FS, may predict significant liver fibrosis on routine abdominal CT scans.