Assessing Liver Hemodynamics in Children With Cholestatic Cirrhosis by Use of Dual-Energy Spectral CT

Assessment of high-risk gastroesophageal varices in cirrhotic patients using quantitative parameters from dual-source dual-energy CT

PURPOSE

To investigate the clinical value of dual-source dual-energy CT (dsDECT) quantitative parameters in evaluating hemodynamics and predicting high-risk gastroesophageal varices in cirrhotic patients.

METHODS

98 consecutive patients were collected in this prospectively study and all patients underwent an abdominal triple-phase contrasted-enhanced examination with dsDECT. Iodine concentration (IC) and normalized iodine concentration (NIC) of the liver parenchyma, spleen parenchyma and aorta at different phases were recorded, and arterial iodine fraction (AIF), iodine washout rate (IWR), and extracellular volume (ECV) were calculated. Using upper gastrointestinal endoscopy as the reference standard, patients who met the inclusion and exclusion criteria were divided into groups with varices need treatment (VNT) and non-VNT. The clinical characteristics, traditional CT features and quantitative dsDECT parameters were compared between the VNT group and the non-VNT group using univariate analysis. The binary logistics analysis was used to build a model for diagnosing VNT. The receiver operating characteristic (ROC) curve was used for analysis and the DeLong test was used to compare different ROC curves.

RESULTS

Finally, 57 patients were included in this study. Univariate analysis showed statistically significant differences in NIC of the liver at the portal venous phase (NIC-LPVP), IWR of the liver (IWR-L) and spleen volume between the VNT group and the non-VNT group (p < 0.05). The mixed-CT model was built by binary logistics analysis. The ROC curves of NIC-LPVP, IWR-L, spleen volume and the mixed-CT model were statistically significant (p < 0.05) for predicting VNT in cirrhotic patients, among which the area under the ROC curve of the mixed-CT model was the highest.

CONCLUSION

Dual-source dual-energy CT has added clinical value in evaluating hepatic hemodynamics and diagnosing VNT in patients with liver cirrhosis.

The evaluation of portal hypertension in cirrhotic patients with spectral computed tomography

BACKGROUND

Iodine concentrations measured using dual-energy spectral CT (DESCT) have been recently proposed as providing good performance for examining tissues hemodynamics.

PURPOSE

To evaluate the diagnostic efficacy of DESCT-derived parameters in evaluating portal venous pressure in patients with liver cirrhosis.

MATERIAL AND METHODS

A total of 71 patients with liver cirrhosis who underwent percutaneous transhepatic portal vein puncture procedures were included in this study. All participants underwent DESCT and gastrointestinal endoscopy within one month before the operation. The direct portal venous pressure of each participant was measured preoperatively.

RESULTS

Stepwise multivariate linear regression analysis showed that the iodine concentrations in the portal vein and hepatic parenchyma during the portal venous phase and the platelet count were independently correlated with the direct portal venous pressure (P < 0.001, P < 0.001, and P = 0.030, respectively). Receiver operating characteristic analysis revealed that the normalized iodine concentration of the hepatic parenchyma had the best performance for identifying clinically significant portal hypertension (≥10 mmHg), esophageal varices, and high-risk esophageal varices (the area under the curve values were 0.951, 0.932, and 0.960, respectively).

CONCLUSION

The normalized iodine concentration of the hepatic parenchyma is a reliable parameter to non-invasively assess portal venous pressure in patients with liver cirrhosis.

Dual-energy CT in diffuse liver disease: is there a role?

Dual-energy CT (DECT) can be defined as the use of two different energy levels to identify and quantify material composition. Since its inception, DECT has benefited from remarkable improvements in hardware and clinical applications. DECT enables accurate identification and quantification of multiple materials, including fat, iron, and iodine. As a consequence, multiple studies have investigated the potential role of DECT in the assessment of diffuse liver diseases. While this role is evolving, this article aims to review the most relevant literature on use of DECT for assessment of diffuse liver diseases. Moreover, the basic concepts on DECT techniques, types of image reconstruction, and DECT-dedicated software will be described, focusing on the areas that are most relevant for the evaluation of diffuse liver diseases. Also, we will review the evidence of added value of DECT in detection and assessment of hepatocellular carcinoma which is a known risk in patients with diffuse liver disease.