Quantification of Hemodynamic Changes in Chronic Liver Disease: Correlation of Perfusion-CT Data with Histopathologic Staging of Fibrosis

Rationale and Objectives: To noninvasively estimate the severity of liver fibrosis using perfusion-CT (PCT)-based quantification of dual liver blood supply prior to liver transplantation or liver resections and to correlate results with histological grading of fibrosis stages and AST-platelet ratio index. Materials and methods: Institutional review board approved this retrospective study. We analysed 41 consecutive patients (19 classified as Child-Pugh A, 17 as Child-Pugh B, and 5 as Child-Pugh C; MELD score ranged from 7 to 28) who underwent PCT prior to liver transplantation/liver resections between 2013 and 2016. The examination protocol included a scan time of 40 s, 80 kV, 100/120 mAs. Arterial liver perfusion, portal-venous perfusion and hepatic perfusion index (HPI) were registered in liver parenchyma by three readers. Fibrosis was histological graded according to Ishak scoring system as liver fibrosis (F3, n = 10), incomplete liver cirrhosis (F5, n = 5), and complete liver cirrhosis (F6, n = 26). Results: Portal-venous perfusion was significantly higher in liver fibrosis (F3 69.5 +/- 23.7 ml/100 ml/min) compared to incomplete liver cirrhosis (F5, 52.9 +/- 25.7 ml/100 ml/min) and complete liver cirrhosis (F6, 46.4 +/- 24.8 ml/100 ml/min (range 6.3-112.0 ml/100 ml/min; F = 15, p < 0.0001). HPI showed the same group differences (F = 20, p < 0.0001; HPI F3: 19.1 +/- 10.7%, HPI F5: 38.5 +/- 24.3%, HPI F6: 43.4 +/- 25.8%). Group comparisons were not significant for arterial liver perfusion (F = 3, p = 0.15). PCT parameters as well as histological fibrosis grading did neither correlate with laboratory findings including AST-platelet ratio index and MELD-Score, nor with Child-Pugh-Score. Conclusion: Quantitative data from perfusion-CT can be used to differentiate between liver fibrosis (F3) and liver cirrhosis (F5/F6).