Erley Jennifer, Breckow Julia, Roedl Kevin, Ozga Ann-Kathrin, Duoerkongjiang Alidan, de Heer Geraldine, Schubert Niklas, Pallasch Fabian, Burdelski Christoph, Kluge Stefan, Yamamura Jin, Adam Gerhard, Molwitz Isabel
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur Radiol. 2025 Aug 6. doi: 10.1007/s00330-025-11851-3.
OBJECTIVES: To analyze changes in the liver dual-energy CT fat fraction (liver DECT FF) at the intensive care unit (ICU), and its prognostic value. MATERIALS AND METHODS: Intubated ICU patients were retrospectively included, who received two clinical DECT (CT1 and CT2) within a minimum interval of 10 days between 11/2019 and 12/2022. The liver DECT FF was determined by combining two regions of interest (ROI) in the right and one ROI in the left liver lobe (minimum area 3.6 cm). The skeletal muscle index, muscle radiodensity attenuation, subcutaneous/visceral adipose tissue area, and waist circumference were assessed. Pre-existing diseases, reasons for ICU admission, ICU scoring systems, and in-hospital mortality were noted. t-tests, Wilcoxon tests, linear or Cox regression, Pearson correlation, and intraclass correlation coefficients (ICC) were employed. RESULTS: Of 76 total patients, 43.4% were female (age 61 ± 12 years) and 97.4% received parenteral nutrition. In-hospital mortality was 60.8%. The liver DECT FF at CT1 was the only parameter associated with in-hospital mortality (hazard ratio: 1.15 [95% confidence interval: 1.07-1.24], p < 0.001), and a shorter ICU stay (-3.66 [-6.29 to -1.02] days, p < 0.007). DECT FF was not associated with ICU scoring systems. It did not relevantly change within a median of 8 days (3.3 ± 5.5% at CT1; 2.7 ± 4.3% at CT2, p = 0.315). Subset inter-observer reproducibility was good (ICC: 0.87 [0.66-0.95]). CONCLUSION: The liver DECT FF may serve as an independent prognostic imaging biomarker of mortality in critically ill patients, with a superior value to single-energy body composition parameters. KEY POINTS: Question Although the risk of liver steatosis is increased in critically ill patients, it is unknown if liver fat content, when quantified using DECT, is of prognostic value. Findings The liver DECT FF is associated with in-hospital mortality in critically ill patients. Clinical relevance The liver DECT FF may be superior for survival prognosis than single-energy CT body composition parameters of muscle and fat tissue at the ICU.
目的：分析重症监护病房（ICU）中肝脏双能CT脂肪分数（肝脏DECT FF）的变化及其预后价值。 材料与方法：回顾性纳入插管的ICU患者，这些患者在2019年11月至2022年12月期间，在至少间隔10天的时间内接受了两次临床双能CT检查（CT1和CT2）。通过结合右肝叶的两个感兴趣区（ROI）和左肝叶的一个ROI（最小面积3.6 cm²）来确定肝脏DECT FF。评估骨骼肌指数、肌肉放射性密度衰减、皮下/内脏脂肪组织面积和腰围。记录既往疾病、ICU入院原因、ICU评分系统和院内死亡率。采用t检验、Wilcoxon检验、线性或Cox回归、Pearson相关性分析和组内相关系数（ICC）。 结果：76例患者中，43.4%为女性（年龄61±12岁），97.4%接受肠外营养。院内死亡率为60.8%。CT1时的肝脏DECT FF是与院内死亡率相关的唯一参数（风险比：1.15 [95%置信区间：1.07 - 1.24]，p < 0.001），且与ICU住院时间缩短相关（-3.66 [-6.29至-1.02]天，p < 0.007）。DECT FF与ICU评分系统无关。在中位数8天内其无显著变化（CT1时为3.3±5.5%；CT2时为2.7±4.3%，p = 0.315）。观察者间子集再现性良好（ICC：0.87 [0.66 - 0.95]）。 结论：肝脏DECT FF可作为危重症患者死亡率的独立预后影像生物标志物，其价值优于单能身体成分参数。 关键点：问题 尽管危重症患者肝脏脂肪变性风险增加，但使用DECT定量时肝脏脂肪含量是否具有预后价值尚不清楚。 发现 肝脏DECT FF与危重症患者的院内死亡率相关。 临床意义 在ICU中，肝脏DECT FF在生存预后方面可能优于肌肉和脂肪组织的单能CT身体成分参数。
Cochrane Database Syst Rev. 2015-1-8
Cochrane Database Syst Rev. 2018-6-8
Cochrane Database Syst Rev. 2018-6-25
Cochrane Database Syst Rev. 2016-5-27
Cochrane Database Syst Rev. 2018-3-27
Cochrane Database Syst Rev. 2015-6-22
Cochrane Database Syst Rev. 2019-9-3
Med Klin Intensivmed Notfmed. 2024-9
Cell Mol Gastroenterol Hepatol. 2022
Zotero 插件