Estimating liver cirrhosis severity with extracellular volume fraction by spectral CT

To investigate the diagnostic value of spectral CT in calculating extracellular volume fraction (ECV) for assessing the severity of liver cirrhosis. This retrospective study enrolled 172 participants, including 127 patients diagnosed with liver cirrhosis and 45 matched controls, all of whom underwent spectral CT hepatic enhancement imaging. Disease severity stratification was performed using the Child-Pugh classification system. ECV values were derived from the iodine density map during the delayed phase. These ECV values were then compared across the control group and subclassified cirrhosis groups (Child-Pugh classes A-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. 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 an independent factor for cirrhosis (OR 1.610, P < 0.001). ECV values measured using spectral CT can serve as a noninvasive biomarker for assessing the severity of liver cirrhosis.