Role of Measurement of Hepatic Hemodynamics by Triphasic CT in the Evaluation of Patients with Liver Cirrhosis

Abstract
Background: Liver biopsy has been the main method for diagnosis, but it is an invasive method, with many complica-tions, so a non-invasive method is needed to assess the severity of liver cirrhosis.
Aim of Study: To assess the severity of liver cirrhosis by measurement of hepatic blood flow using triphasic CT.
Patients and Methods: Our case control, single centre study involved 30 patients with chronic diffuse parenchymatous liver disease (which were further divided into Child-Pugh A, B, and C subgroups) and 30 healthy volunteers. All cases underwent supervision of their medical history, clinical ex-amination, liver function tests, and triphasic CT scan. Meas-urement of contrast enhancement fraction (CEF) as a parameter of hepatic blood flow was calculated using triphasic CT, assessment of ROI (region of interest) in HU for the hepatic parenchyma in both arterial and venous phases were done. The contrast enhancement (CEF) was obtained by dividing the contrast concentration in the hepatic arterial phase by that in the portal venous phase using ROI measurement in HU. CEF values and the ROI measurements from the study and control groups were compared.
Results: The differences in the ROI measurements were statistically significant between the subgroups with multiple comparisons, except between the control and the Child-Pugh (A) group. The ROI measurement in the portal phase was higher than that measured in the hepatic arterial phase in both the study and control groups. There was a decrease in ROI measurement in both the arterial and portal phases with increase of the Child-Pugh grade; more evident in the portal phase. The value of CEF in the control group was 0.74. The CEF values increased with increasing Child-Pugh grades in the study group. There were noticeable differences for CEF between Child-Pugh A and B groups, Child-Pugh A and C groups and Child-Pugh B and C groups. The CEF increased as liver function (Child-Pugh grade) deteriorated in the study group.
Conclusion: Measurement of hepatic blood flow and CEF by using triphasic CT can be used to evaluate the liver hemo-dynamics and severity of liver cirrhosis.