Noninvasive assessment of liver segmental volumes and its relationship with 5-year prognostication

Purpose: This study aimed to analyze the predictive value of liver segmental
volume and attenuation ratio (LSVR/LSVAR), and caudate to right lobe ratio
(CRL-R) for chronic liver disease (CLD) on routine abdominal CT scans and
to predict the 5-year probability of transplant-free survival and first hepatic
decompensation.

Material and Methods: This retrospective study included 108 patients without
CLD (noCLD-group; n=108), as well as 98 patients with biopsy-proven CLD.
All patients underwent abdominal CT scans between 03/2015 and 08/2017.
Patients with CLD were divided into three groups: early CLD (F0–F2; eCLD;
n=40), advanced CLD (F3–F4; aCLD; n=20), and aCLD with clinically significant portal hypertension according to the BAVENO VII consensus (aCLDPH;
n=38). CRL-R, LSVR, and LSVAR were compared between the groups using
Kruskal–Wallis test and receiver operating characteristic (ROC) analysis to
determine cutoff values. The 5-year transplant-free survival and first hepatic
decompensation were assessed by Kaplan–Meier curve analysis.

Results: CRL-R, LSVR and LSVAR differed significantly between all the
groups (p<0.001). A CRL-R cutoff value of >0.93 predicted aCLD with a sensitivity of 69% and a specificity of 78%, while LSVR >0.37 had a sensitivity
of 68% and a specificity of 80%. Patients with both CRL-R >0.99 and LSVR
>0.37 had the lowest probability of 5-year transplant-free survival (46%) and
the lowest probability of a decompensation-free 5-year course (75%), which
was significantly different (p<0.001) from patients with both CRL-R <0.99 and
LSVR <0.37 (86%; 98%).

Conclusion: LSVR/LSVAR and CRL-R on routine abdominal CT scans showed
a high predictive value for CLD and 5-year outcome prognostication.