Abdominal radiology (New York) · 2026
Dual-layer spectral CT-derived iodine and extracellular volume biomarkers for noninvasive assessment of hepatic fibrosis in Fontan-associated liver disease.
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Inmutto Nakarin, Srisuwan Tanop, Nimitrungtawee Natthapong, Sethasathien Saviga, Kongkarnka Sarawut, Na Chiangmai Wittanee
Аннотация
PURPOSE: To evaluate the diagnostic performance of delayed-phase dual-layer spectral CT-derived normalized iodine concentration and extracellular volume fraction for noninvasive assessment of hepatic fibrosis in patients with Fontan-associated liver disease.
METHODS: This single-center exploratory retrospective study included 23 patients with Fontan-associated liver disease who underwent both liver biopsy and delayed-phase dual-layer spectral CT between January 2021 and December 2023. Normalized iodine concentration was calculated as hepatic iodine concentration divided by aortic iodine concentration. Hematocrit-adjusted extracellular volume fraction (ECV) was calculated from delayed-phase iodine-density maps. Histologic fibrosis stage based on the METAVIR system was used as the reference standard. Associations between CT biomarkers and fibrosis stage were assessed using the Kruskal-Wallis test, Jonckheere-Terpstra trend test, and Spearman correlation. Diagnostic performance for advanced fibrosis (≥ F3) and cirrhosis (F4) was evaluated using receiver operating characteristic analysis.
RESULTS: Histologic fibrosis stages were F1 in 4 patients, F2 in 2, F3 in 9, and F4 in 8. ECV was higher in advanced fibrosis stages, with median values of 39.21% in F1, 37.15% in F2, 42.72% in F3, and 46.78% in F4. ECV differed significantly among fibrosis stages (p = 0.014), showed a significant ordered trend (p < 0.001), and correlated positively with histologic stage (ρ = 0.666, p < 0.001). IC-normalized showed a weak positive correlation with fibrosis stage, but the ordered trend did not reach statistical significance. For advanced fibrosis, ECV showed promising preliminary discrimination, with an AUC of 0.902 (95% CI, 0.766-1.000). For cirrhosis, ECV showed an AUC of 0.833 (95% CI, 0.655-1.000), with sensitivity of 87.5%, specificity of 80.0%, and negative predictive value of 92.3% at a cutoff of 43.45%.
CONCLUSION: In this single-center exploratory study, delayed-phase dual-layer spectral CT-derived ECV showed a significant association with histologic fibrosis severity and promising preliminary discrimination for advanced fibrosis and cirrhosis in Fontan-associated liver disease. External validation in larger, independent Fontan cohorts is required before clinical application.
METHODS: This single-center exploratory retrospective study included 23 patients with Fontan-associated liver disease who underwent both liver biopsy and delayed-phase dual-layer spectral CT between January 2021 and December 2023. Normalized iodine concentration was calculated as hepatic iodine concentration divided by aortic iodine concentration. Hematocrit-adjusted extracellular volume fraction (ECV) was calculated from delayed-phase iodine-density maps. Histologic fibrosis stage based on the METAVIR system was used as the reference standard. Associations between CT biomarkers and fibrosis stage were assessed using the Kruskal-Wallis test, Jonckheere-Terpstra trend test, and Spearman correlation. Diagnostic performance for advanced fibrosis (≥ F3) and cirrhosis (F4) was evaluated using receiver operating characteristic analysis.
RESULTS: Histologic fibrosis stages were F1 in 4 patients, F2 in 2, F3 in 9, and F4 in 8. ECV was higher in advanced fibrosis stages, with median values of 39.21% in F1, 37.15% in F2, 42.72% in F3, and 46.78% in F4. ECV differed significantly among fibrosis stages (p = 0.014), showed a significant ordered trend (p < 0.001), and correlated positively with histologic stage (ρ = 0.666, p < 0.001). IC-normalized showed a weak positive correlation with fibrosis stage, but the ordered trend did not reach statistical significance. For advanced fibrosis, ECV showed promising preliminary discrimination, with an AUC of 0.902 (95% CI, 0.766-1.000). For cirrhosis, ECV showed an AUC of 0.833 (95% CI, 0.655-1.000), with sensitivity of 87.5%, specificity of 80.0%, and negative predictive value of 92.3% at a cutoff of 43.45%.
CONCLUSION: In this single-center exploratory study, delayed-phase dual-layer spectral CT-derived ECV showed a significant association with histologic fibrosis severity and promising preliminary discrimination for advanced fibrosis and cirrhosis in Fontan-associated liver disease. External validation in larger, independent Fontan cohorts is required before clinical application.