The clinical value of hepatic extracellular volume fraction using routine multiphasic contrast-enhanced liver CT for staging liver fibrosis

摘要

Liver fibrosis (LF) is a common pathway of liver injury for multiple chronic liver conditions. Chronic viral hepatitis, metabolic, autoimmune, and cholestatic liver diseases amongst others can lead to clinically significant LF.1, 2, 3, 4 The assessment of LF is a key element to determine prognosis, to manage treatment, to monitor disease progression, and assess response to therapy in patients with chronic liver disease.5, 6 As LF progresses, activated stellate cells proliferate, extracellular matrix deposits increase,7, 8 and extracellular space is expanded compared with the normal surrounding liver parenchyma. Previous studies have demonstrated that computed tomography (CT) may be able to estimate the hepatic extracellular volume fraction (fECV) because contrast media freely traverse between intravascular and extravascular spaces reaching a state of equilibrium regarding concentration9, 10; however, these studies used the prolonged delayed phase (10 minutes) and/or macromolecular contrast agents,9 which do not allow the direct extrapolation of data to multiphasic contrast-enhanced CT in routine clinical practice. Therefore, the objective of the present study was to determine whether fECVs measured using multiphasic liver CT (using a 180-second delayed phase and routine contrast medium) can be used to quantify the severity of LF.