Computed  tomography findings in liver fibrosis and cirrhosis

Adrian Huber; Lukas Ebner; Matteo Montani; Nasser Semmo; Kingshuk Roy Choudhury; Johannes Heverhagen; Andreas Christe

doi:10.4414/smw.2014.13923

Original article

Vol. 144 No. 0708 (2014)

Computed tomography findings in liver fibrosis and cirrhosis

Adrian Huber
Lukas Ebner
Matteo Montani
Nasser Semmo
Kingshuk Roy Choudhury
Johannes Heverhagen
Andreas Christe

DOI: https://doi.org/10.4414/smw.2014.13923
Cite this as:: Swiss Med Wkly. 2014;144:w13923
Published: 09.02.2014

Summary

PRINCIPLES: Computed tomography (CT) is inferior to the fibroscan and laboratory testing in the noninvasive diagnosis of liver fibrosis. On the other hand, CT is a frequently used diagnostic tool in modern medicine. The auxiliary finding of clinically occult liver fibrosis in CT scans could result in an earlier diagnosis. The aim of this study was to analyse quantifiable direct signs of liver remodelling in CT scans to depict liver fibrosis in a precirrhotic stage.

METHODS: Retrospective review of 148 abdominal CT scans (80 liver cirrhosis, 35 precirrhotic fibrosis and 33 control patients). Fibrosis and cirrhosis were histologically proven. The diameters of the three main hepatic veins were measured 1–2 cm before their aperture into the inferior caval vein. The width of the caudate and the right hepatic lobe were divided, and measured horizontally at the level of the first bifurcation of the right portal vein in axial planes (caudate-right-lobe ratio). A combination of both (sum of liver vein diameters divided by the caudate-right lobe ratio) was defined as the ld/crl ratio. These metrics were analysed for the detection of liver fibrosis and cirrhosis.

RESULTS: An ld/crl-r <24 showed a sensitivity of 83% and a specificity of 76% for precirrhotic liver fibrosis. Liver cirrhosis could be detected with a sensitivity of 88% and a specificity of 82% if ld/crl-r <20.

CONCLUSION: An ld/crl-r <24 justifies laboratory testing and a fibroscan. This could bring forward the diagnosis and patients would profit from early treatment in a potentially reversible stage of disease.

References

Poynard T, Mathurin P, Lai C-L, Guyader D, Poupon R, Tainturier M-H, et al. A comparison of fibrosis progression in chronic liver diseases. J Hepatol. 2003;38(3):257–65.
Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.
Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: From steatosis to cirrhosis. Hepatology. 2006;43(S1):S99–S112.
Flier JS, Underhill LH, Friedman SL. The Cellular Basis of Hepatic Fibrosis – Mechanisms and Treatment Strategies. N Engl J Med. 1993;328(25):1828–35.
Gentilini P, Laffi G, La Villa G, Romanelli RG, Buzzelli G, Casini-Raggi V, et al. Long course and prognostic factors of virus-induced cirrhosis of the liver. Am J Gastroenterol. 92(1):66–72.
Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterol. 2001;120(3):726–48.
Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705–13.
Rustogi R, Horowitz J, Harmath C, Wang Y, Chalian H, Ganger DR, et al. Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. J Magn Reson Imag. 2012;35(6):1356–64.
Faria SC, Ganesan K, Mwangi I, Shiehmorteza M, Viamonte B, Mazhar S, et al. MR imaging of liver fibrosis: current state of the art. Radiographics. 2009;29(6):1615–35.
Taouli B, Tolia AJ, Losada M, Babb JS, Chan ES, Bannan MA, et al. Diffusion-Weighted MRI for Quantification of Liver Fibrosis: Preliminary Experience. AJR. 2007;189(4):799–806.
Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H, et al. Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. Intervirology. 2008;51(1):17–26.
Brown JJ, Naylor MJ, Yagan N. Imaging of hepatic cirrhosis. Radiology. 1997;202(1):1–16.
Gupta D, Chawla YK, Dhiman RK, Suri S, Dilawari JB. Clinical significance of patent paraumbilical vein in patients with liver cirrhosis. Digest Dis Sci. 2000;45(9):1861–4.
Karahan OI, Dodd GD, Chintapalli KN, Rhim H, Chopra S. Gastrointestinal Wall Thickening in Patients with Cirrhosis: Frequency and Patterns at Contrast-Enhanced CT1. Radiology. 2000;215(1):103–7.
Dodd GD, Baron RL, Oliver JH, Federle MP. Spectrum of Imaging Findings of the Liver in End-Stage Cirrhosis: Part I, Gross Morphology and Diffuse Abnormalities. AJR. 1999;173(4):1031–6.
Brancatelli G, Federle MP, Ambrosini R, Lagalla R, Carriero A, Midiri M, et al. Cirrhosis: CT and MR imaging evaluation. Eur J Radiol. 2007;61(1):57–69.
Ito K, Mitchell DG, Kim M-J, Awaya H, Koike S, Matsunaga N. Right posterior hepatic notch sign: A simple diagnostic MR finding of cirrhosis. J Magn Reson Imag. 2003;18(5):561–6.
Awaya H, Mitchell DG, Kamishima T, Holland G, Ito K, Matsumoto T. Cirrhosis: Modified Caudate – Right Lobe Ratio. Radiol. 2002;224(3):769–74.
Zhang Y, Zhang XM, Prowda JC, Zhang HL, Sant’Anna Henry C, Shih G, et al. Changes in hepatic venous morphology with cirrhosis on MRI. J Magn Reson Imag. 2009;29(5):1085–92.
Ishak KG. Pathologic features of chronic hepatitis: A review and update. AJCP. 2000;113(1):40–55.
Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. Hepatology. 1996;24(2):289–93.
Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467–74.
Anderson TW, Anderson TW, Anderson TW, Anderson TW. An introduction to multivariate statistical analysis [Internet]. Wiley New York; 1958 [cited 2012 Oct 13]. Available from: http://www.lavoisier.fr/livre/notice.asp
Ihaka R, Gentleman R. R: A Language for Data Analysis and Graphics. J Comput Graph Stat. 1996;5(3):299–314.
Lafortune M, Marleau D, Breton G, Viallet A, Lavoie P, Huet PM. Portal venous system measurements in portal hypertension. Radiology. 1984;151(1):27–30.
Vergara S, Macìas J, Rivero A, Gutiérrez-Valencia A, Gonzàlez-Serrano M, Merino D, et al. The use of transient elastometry for assessing liver fibrosis in patients with HIV and hepatitis C virus coinfection. Clin Infect Dis. 2007;45(8):969–74.
Okazaki H, Ito K, Fujita T, Koike S, Takano K, Matsunaga N. Discrimination of Alcoholic from Virus-Induced Cirrhosis on MR Imaging. AJR. 2000;175(6):1677–81.

How to Cite

1.

Huber A, Ebner L, Montani M, Semmo N, Roy Choudhury K, Heverhagen J, Christe A. Computed tomography findings in liver fibrosis and cirrhosis. Swiss Med Wkly [Internet]. 2014 Feb. 9 [cited 2024 Apr. 19];144(0708):w13923. Available from: https://smw.ch/index.php/smw/article/view/1824

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Poynard T, Mathurin P, Lai C-L, Guyader D, Poupon R, Tainturier M-H, et al. A comparison of fibrosis progression in chronic liver diseases. J Hepatol. 2003;38(3):257–65.

[2] Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.

[3] Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: From steatosis to cirrhosis. Hepatology. 2006;43(S1):S99–S112.

[4] Flier JS, Underhill LH, Friedman SL. The Cellular Basis of Hepatic Fibrosis – Mechanisms and Treatment Strategies. N Engl J Med. 1993;328(25):1828–35.

[5] Gentilini P, Laffi G, La Villa G, Romanelli RG, Buzzelli G, Casini-Raggi V, et al. Long course and prognostic factors of virus-induced cirrhosis of the liver. Am J Gastroenterol. 92(1):66–72.

[6] Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterol. 2001;120(3):726–48.

[7] Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705–13.

[8] Rustogi R, Horowitz J, Harmath C, Wang Y, Chalian H, Ganger DR, et al. Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. J Magn Reson Imag. 2012;35(6):1356–64.

[9] Faria SC, Ganesan K, Mwangi I, Shiehmorteza M, Viamonte B, Mazhar S, et al. MR imaging of liver fibrosis: current state of the art. Radiographics. 2009;29(6):1615–35.

[10] Taouli B, Tolia AJ, Losada M, Babb JS, Chan ES, Bannan MA, et al. Diffusion-Weighted MRI for Quantification of Liver Fibrosis: Preliminary Experience. AJR. 2007;189(4):799–806.

[11] Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H, et al. Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. Intervirology. 2008;51(1):17–26.

[12] Brown JJ, Naylor MJ, Yagan N. Imaging of hepatic cirrhosis. Radiology. 1997;202(1):1–16.

[13] Gupta D, Chawla YK, Dhiman RK, Suri S, Dilawari JB. Clinical significance of patent paraumbilical vein in patients with liver cirrhosis. Digest Dis Sci. 2000;45(9):1861–4.

[14] Karahan OI, Dodd GD, Chintapalli KN, Rhim H, Chopra S. Gastrointestinal Wall Thickening in Patients with Cirrhosis: Frequency and Patterns at Contrast-Enhanced CT1. Radiology. 2000;215(1):103–7.

[15] Dodd GD, Baron RL, Oliver JH, Federle MP. Spectrum of Imaging Findings of the Liver in End-Stage Cirrhosis: Part I, Gross Morphology and Diffuse Abnormalities. AJR. 1999;173(4):1031–6.

[16] Brancatelli G, Federle MP, Ambrosini R, Lagalla R, Carriero A, Midiri M, et al. Cirrhosis: CT and MR imaging evaluation. Eur J Radiol. 2007;61(1):57–69.

[17] Ito K, Mitchell DG, Kim M-J, Awaya H, Koike S, Matsunaga N. Right posterior hepatic notch sign: A simple diagnostic MR finding of cirrhosis. J Magn Reson Imag. 2003;18(5):561–6.

[18] Awaya H, Mitchell DG, Kamishima T, Holland G, Ito K, Matsumoto T. Cirrhosis: Modified Caudate – Right Lobe Ratio. Radiol. 2002;224(3):769–74.

[19] Zhang Y, Zhang XM, Prowda JC, Zhang HL, Sant’Anna Henry C, Shih G, et al. Changes in hepatic venous morphology with cirrhosis on MRI. J Magn Reson Imag. 2009;29(5):1085–92.

[20] Ishak KG. Pathologic features of chronic hepatitis: A review and update. AJCP. 2000;113(1):40–55.

[21] Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. Hepatology. 1996;24(2):289–93.

[22] Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467–74.

[23] Anderson TW, Anderson TW, Anderson TW, Anderson TW. An introduction to multivariate statistical analysis [Internet]. Wiley New York; 1958 [cited 2012 Oct 13]. Available from: http://www.lavoisier.fr/livre/notice.asp

[24] Ihaka R, Gentleman R. R: A Language for Data Analysis and Graphics. J Comput Graph Stat. 1996;5(3):299–314.

[25] Lafortune M, Marleau D, Breton G, Viallet A, Lavoie P, Huet PM. Portal venous system measurements in portal hypertension. Radiology. 1984;151(1):27–30.

[26] Vergara S, Macìas J, Rivero A, Gutiérrez-Valencia A, Gonzàlez-Serrano M, Merino D, et al. The use of transient elastometry for assessing liver fibrosis in patients with HIV and hepatitis C virus coinfection. Clin Infect Dis. 2007;45(8):969–74.

[27] Okazaki H, Ito K, Fujita T, Koike S, Takano K, Matsunaga N. Discrimination of Alcoholic from Virus-Induced Cirrhosis on MR Imaging. AJR. 2000;175(6):1677–81.