Chen Yao, Xi Yuzhen, Zhao Fanfan, Li Huanhuan, Zhou Min, Xu Yue, Fan Shufeng, Liu Miao
Department of Radiology, Affiliated Xihu Hospital of Hangzhou Medical College, Hangzhou, China.
Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):8553-8566. doi: 10.21037/qims-24-2110. Epub 2025 Aug 11.
Drug-induced liver injury (DILI) has become a major cause of acute liver failure, and its incidence has been increasing steadily in recent years. This study aimed to compare the clinical and computed tomography (CT) imaging features of the variable biochemical damage and severity of DILI to establish a radiological model for predicting high-risk DILI based on CT image features.
The eligible patients with DILI (January 2016 to March 2024) who underwent serum laboratory examination and contrast abdominal CT within 3 months of onset were retrospectively analyzed at Affiliated Xihu Hospital of Hangzhou Medical College (Institution I) and The Second Affiliated Hospital of Zhejiang Chinese Medical University (Institution II). The severity-associated CT features were determined via binomial logistic regression analysis, and the efficacy of the different models were compared. The odds ratios (ORs) and corresponding 95% confidence intervals (CIs) provided were not adjusted.
The injury types included hepatocellular (n=68, 45.64%), mixed (n=28, 18.79%), and cholestatic (n=53, 35.57%). The proportion of splenomegaly in patients with cholestatic injury (56.60%) was significantly higher than that in those with hepatocellular (35.71%) and mixed injury (22.06%) (P<0.001). Regarding severity, 127 (85.23%) patients had mild-to-moderate injury, and 22 (14.77%) had severe-to-fatal injury or required liver transplantation (LT). Injury severity was independently associated with quantitative liver-spleen contrast (Q-LSC) (OR =0.002; 95% CI: 0.00-0.13), and ascites (OR =70.83; 95% CI: 16.34-306.99). The prediction of the new model employing Q-LSC and ascites for high-risk DILI demonstrated excellent performance [area under the receiver operating characteristic (ROC) curve (AUC) =0.929; sensitivity=0.818; specificity =0.953].
Statistical differences are observed in the serum biomarkers of DILI according to varying biochemical damage and degree of severity. Q-LSC and ascites were associated with the severity of DILI, and a combined model incorporating Q-LSC and ascites can effectively predict high-risk DILI.
药物性肝损伤（DILI）已成为急性肝衰竭的主要原因，近年来其发病率呈稳步上升趋势。本研究旨在比较DILI不同生化损伤和严重程度的临床及计算机断层扫描（CT）影像特征，基于CT图像特征建立预测高危DILI的放射学模型。
回顾性分析杭州医学院附属西湖医院（机构I）和浙江中医药大学附属第二医院（机构II）2016年1月至2024年3月期间发病3个月内接受血清实验室检查及腹部增强CT的符合条件的DILI患者。通过二项逻辑回归分析确定与严重程度相关的CT特征，并比较不同模型的效能。所提供的比值比（OR）及相应的95%置信区间（CI）未作调整。
损伤类型包括肝细胞型（n = 68，45.64%）、混合型（n = 28，18.79%）和胆汁淤积型（n = 53，35.57%）。胆汁淤积型损伤患者脾肿大的比例（56.60%）显著高于肝细胞型（35.71%）和混合型损伤患者（22.06%）（P < 0.001）。在严重程度方面，127例（85.23%）患者为轻至中度损伤，22例（14.77%）为重度至致命性损伤或需要肝移植（LT）。损伤严重程度与肝脏-脾脏定量对比（Q-LSC）（OR = 0.002；95% CI：0.00 - 0.13）及腹水（OR = 70.83；95% CI：16.34 - 306.99）独立相关。采用Q-LSC和腹水预测高危DILI的新模型表现优异[受试者操作特征（ROC）曲线下面积（AUC） = 0.929；灵敏度 = 0.818；特异度 = 0.953]。
根据不同的生化损伤和严重程度，DILI的血清生物标志物存在统计学差异。Q-LSC和腹水与DILI的严重程度相关，结合Q-LSC和腹水的联合模型可有效预测高危DILI。
