Dual-layer spectral CT–derived iodine and extracellular volume biomarkers for noninvasive assessment of hepatic fibrosis in Fontan-associated liver disease

Information from the abstract

To evaluate the diagnostic performance of delayed-phase dual-layer spectral CT-derived normalized iodine concentration and extracellular volume fraction for noninvasive assessment of hepatic fibrosis in patients with Fontan-associated liver disease. This single-center exploratory retrospective study included 23 patients with Fontan-associated liver disease who underwent both liver biopsy and delayed-phase dual-layer spectral CT between January 2021 and December 2023. Normalized iodine concentration was calculated as hepatic iodine concentration divided by aortic iodine concentration. Hematocrit-adjusted extracellular volume fraction (ECV) was calculated from delayed-phase iodine-density maps. Histologic fibrosis stage based on the METAVIR system was used as the reference standard. Associations between CT biomarkers and fibrosis stage were assessed using the Kruskal–Wallis test, Jonckheere–Terpstra trend test, and Spearman correlation. Diagnostic performance for advanced fibrosis (≥ F3) and cirrhosis (F4) was evaluated using receiver operating characteristic analysis. Histologic fibrosis stages were F1 in 4 patients, F2 in 2, F3 in 9, and F4 in 8. ECV was higher in advanced fibrosis stages, with median values of 39.21% in F1, 37.15% in F2, 42.72% in F3, and 46.78% in F4. ECV differed significantly among fibrosis stages ( p = 0.014), showed a significant ordered trend ( p < 0.001), and correlated positively with histologic stage (ρ = 0.666, p < 0.001). IC-normalized showed a weak positive correlation with fibrosis stage, but the ordered trend did not reach statistical significance. For advanced fibrosis, ECV showed promising preliminary discrimination, with an AUC of 0.902 (95% CI, 0.766–1.000). For cirrhosis, ECV showed an AUC of 0.833 (95% CI, 0.655–1.000), with sensitivity of 87.5%, specificity of 80.0%, and negative predictive value of 92.3% at a cutoff of 43.45%. In this single-center exploratory study, delayed-phase dual-layer spectral CT-derived ECV showed a significant association with histologic fibrosis severity and promising preliminary discrimination for advanced fibrosis and cirrhosis in Fontan-associated liver disease. External validation in larger, independent Fontan cohorts is required before clinical application.

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