Role of perfusion computed tomography for diagnostic intermediate stages of fibrosis in diffuse liver diseases: prospective study
Authors: Ioppa E. A. , Zavadovskaya V. D. , Tonkih O. S. 
Published: April 2023

INTRODUCTION: Despite the wide availability of the use of ultrasonic elastography to assess fibrosis in patients with diffuse liver diseases, this method didn’t have a high specificity for diagnosing intermediate stages of fibrosis.

OBJECTIVE: To evaluate the diagnostic effectiveness of perfusion computed tomography (PCT) for detecting intermediate stages of fibrosis in patients with diffuse liver diseases.

MATERIALS AND METHODS: PCT of the liver was performed in 73 patients (37 men, 36 women, mean age 47.2±4.4 years). All patients underwent a biochemical blood test, ultrasound elastography, PCT, based on the obtained biochemical blood test and instrumental data, the examined patients were divided into three groups depending on diffuse liver disease: hepatitis (n=25), cirrhosis (n=26), non-alcoholic inflammatory liver disease (n=22). Statistics: The results were processed using the Statistica 10.0 for Windows software package. Identification of the relationship between two quantitative variables that do not obey the normal distribution law was carried out using the Spearman rank correlation coefficient. To assess the diagnostic efficiency of perfusion parameters in patients with DLD, an ROC-analysis (Receiver Operating Characteristic Analysis) was performed. In all statistical analysis procedures, changes were considered statistically significant at a significance level of p<0.05. RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p><0.04), in patients with alcoholic cirrhosis (r=0.66; p><0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p><0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p><0.001), with viral hepatitis — HAF and elastography index (r=0.66; p><0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p><0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p><0.0001). DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited. CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.> p<0.05.

RESULTS: BV correlated in all three groups of diseases with the elastography in patients with viral hepatitis — (r=–0.5; p<0.04), in patients with alcoholic cirrhosis (r=0.66; p><0.02), in patients with non-alcoholic inflammatory liver disease (r=–0.55; p<0.02). ><0.02). In patients with alcoholic hepatitis — correlation between HAF and elastography index (r=0.98; p<0.001), with viral hepatitis — HAF and elastography index (r=0.66; p><0.01). MTT was statistically correlated with elastography index in patients in the alcoholic cirrhosis group (r=0.78; p<0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p><0.0001). >p<0.006). The BF had the highest diagnostic effectiveness for differentiating F1 and F2 fibrosis in patients with diffuse liver diseases (p<0.0001). ><0.0001).

DISCUSSION: PCT is able to differentiate between minimal and intermediate fibrosis, which accompany not only hepatitis, but also non-alcoholic fatty liver disease, whose diagnosis is very relevant, and the use of ultrasound elastography is limited.

CONCLUSION: The BF promotes to the differentiation of intermediate stages of fibrosis, and in combination with ultrasonic elastography can provide a promising direction for the dynamic monitoring of the parenchyma in patients with diffuse liver diseases.