The Liver Segmental Volume Ratio for Noninvasive Detection of Cirrhosis: Comparison With Established Linear and Volumetric Measures.

OBJECTIVE

The aim of this study was to compare the liver segmental volume ratio (LSVR), a novel volumetric computed tomography measurement, with established linear measurements for differentiating normal from cirrhotic livers.

METHODS

Hepatic volumes were measured using semiautomated software (Liver Analysis Application, Philips IntelliSpace Portal) on contrast-enhanced abdominal computed tomography scans in 312 adults, including 108 patients with end-stage liver disease (mean age, 55 years; 63 men/45 women) and 204 healthy controls (potential renal donors; mean age, 46 years; 82 men/122 women). The LSVR was defined as the volume ratio of Couinaud segments I to III to segments IV to VIII. Linear measures included the caudate-to-right lobe ratio and maximal splenic dimension.

RESULTS

Differences in LSVR between cirrhotics and controls were highly significant (P < 0.0001; mean, 0.55 ± 0.29 versus 0.27 ± 0.07; receiver operating characteristic [ROC] area under the curve [AUC], 0.916). Linear caudate-to-right lobe ratio differences were not statistically significant between the 2 cohorts (P = 0.051; ROC AUC, 0.567). Total liver volume was ineffective for discrimination (ROC AUC, 0.598). An LSVR threshold of 0.35 or greater had a sensitivity and specificity for cirrhosis of 81.5% and 88.7%, respectively.

CONCLUSIONS

Regional hepatic volume changes, as reflected by the LSVR, are more effective than standard linear measures or total liver volume for differentiating cirrhotic from normal livers.