Liver fibrosis assessment with multiphasic dual-energy CT: diagnostic performance of iodine uptake parameters

Objectives To evaluate the ability of iodine uptake parameters from hepatic multiphasic CT to predict liver fibrosis, and compare absolute contrast enhancement (Delta HU) with dual-energy iodine density (ID) methods. Methods One hundred seventeen patients with pathologically proven liver fibrosis who underwent dual-energy CT during portal-venous phase (PVP) and 3-min delayed phase (DP) between January 2017 and Octotber 2019 were retrospectively included. Two radiologists measured the hepatic and blood-pool iodine uptake using Delta HU and ID methods; extracellular volume fraction (ECV) and the iodine washout rate (IWR) calculated with both methods were compared between different fibrosis stages (F0-1 vs. F2-4, F0-2 vs. F3-4, or F0-3 vs. F4). The inter-observer reproducibility (intraclass correlation coefficients [ICCs]) for ECV and IWR was compared between the Delta HU and ID methods. The areas under the receiver operating characteristic curves (AUCs) to predict liver fibrosis severity were calculated for serum and imaging fibrosis markers. To identify independent predictors, multivariable logistic regression analysis was performed, and combined performance was assessed for the Delta HU and ID models. Results Patients with F >= 2 (n = 70), F >= 3 (n = 51), and F4 (n = 29) had higher ECV and lower IWR than those with F <= 1, F <= 2, and F <= 3, respectively (all p < 0.001). ICCs were higher in the ID method than in the Delta HU method (ECV: p = 0.045; IWR: p < 0.001). The AUC ranges of ECV Delta HU, ECVID, IWR Delta HU, and IWRID for predicting liver fibrosis severity were 0.65-0.71, 0.67-0.73, 0.76-0.81, and 0.81-0.85, respectively. IWR and fibrosis-4 index were independent predictors, with combined AUCs of 0.82-0.87 for the Delta HU model and 0.86-0.89 for the ID model. Conclusions IWR more accurately predicted liver fibrosis than ECV in routine multiphasic CT. The dual-energy ID method yielded higher inter-observer reproducibility and predictive values than the single-energy Delta HU method.

Automated summary

In evaluating 117 patients with pathologically proven liver fibrosis, it was found that iodine uptake parameters from hepatic multiphasic CT can more accurately predict liver fibrosis, and the dual-energy iodine density method has higher inter-observer reproducibility and predictive values compared to the single-energy contrast enhancement method.