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Does providing routine liver volume assessment add value when performing CT surveillance in cirrhotic patients?

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

The measurement of liver volume (LV) is considered to be an effective prognosticator for postoperative liver failure in patients undergoing hepatectomy. It is unclear whether LV can be used to predict mortality in cirrhotic patients.

Methods

We enrolled 584 consecutive cirrhotic patients who underwent computerized topography (CT) of the abdomen for hepatocellular carcinoma surveillance and 50 age, gender, race, and BMI-matched controls without liver disease. Total LV (TLV), functional LV (FLV), and segmental liver volume (in cm3) were measured from CT imaging. Cirrhotic subjects were followed until death, liver transplantation, or study closure date of July 31, 2016. The survival data were assessed with log-rank statistics and independent predictors of survival were performed using Cox hazards model.

Results

Cirrhotic subjects had significantly lower TLV, FLV, and segmental (all except for segments 1, 6, 7) volume when compared to controls. Subjects presenting with hepatic encephalopathy had significantly lower TLV and FLV than those without HE (p = 0.002). During the median follow-up of 1145 days, 112 (19%) subjects were transplanted and 131 (23%) died. TLV and FLV for those who survived were significantly higher than those who were transplanted or dead (TLV:1740 vs. 1529 vs. 1486, FLV 1691 vs. 1487 vs. 1444, p < 0.0001). In the Cox regression model, age, MELD score, TLV, or FLV were independent predictors of mortality.

Conclusion

Baseline liver volume is an independent predictor of mortality in subjects with cirrhosis. Therefore, it may be useful to provide these data while performing routine surveillance CT scan as an important added value. Further studies are needed to validate these findings and to better understand their clinical utility.

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Abbreviations

APRI:

Aspartate to platelet ratio index

CT:

Computer tomography

ELF:

Enhanced liver fibrosis

Fib-4:

Fibrosis-4

FLV:

Functional liver volume

LS:

Liver stiffness

MELD:

Model for end stage liver disease

TLV:

Total liver volume

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Funding

This work was partly supported by VA Merit Award 1I01CX000361 and NIH R01 AA025208 (to S.L).

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Author notes

  1. Milan Patel, Pimpitcha Puangsricharoen, and Hafiz Muhammad Sharjeel Arshad have contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA

    Milan Patel

  2. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd, UH 4100, Indianapolis, IN, 46202, USA

    Pimpitcha Puangsricharoen, Sam Garrison, Witina Techasatian, Marwan Ghabril & Suthat Liangpunsakul

  3. Chulalongkorn University, Bangkok, Thailand

    Pimpitcha Puangsricharoen

  4. University of Illinois at Urbana, Urbana, IL, USA

    Hafiz Muhammad Sharjeel Arshad

  5. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd, UH 0655, Indianapolis, IN, 46202, USA

    Kumar Sandrasegaran & Mark Tann

  6. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA

    Suthat Liangpunsakul

  7. Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA

    Suthat Liangpunsakul

Authors
  1. Milan Patel
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Contributions

Data collection (MP, PP, MA, SG, and WT), data analysis and interpretation of data (MG, MT, and SL), and manuscript writing, critical review, and corrections (MG, MT, KS, and SL).

Corresponding authors

Correspondence to Suthat Liangpunsakul or Mark Tann.

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Patel, M., Puangsricharoen, P., Arshad, H.M.S. et al. Does providing routine liver volume assessment add value when performing CT surveillance in cirrhotic patients?. Abdom Radiol 44, 3263–3272 (2019). https://doi.org/10.1007/s00261-019-02145-6

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  • DOI: https://doi.org/10.1007/s00261-019-02145-6

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