Use of CT Scans to Monitor Liver Fibrosis in People with Hepatitis C

Liver biopsy is regarded as the "gold standard" for diagnosing and staging liver fibrosis in people with hepatitis C, but the procedure is unpleasant, costly, and carries a small risk of complications. Thus, researchers have explored a variety of non-invasive methods, including blood tests and external imaging, to monitor liver disease progression without repeated biopsies.

Spanish researchers reported the results of study of one such method - computed tomography, or CT scans - in the December 20, 2007 advance online edition of the journal Hepatology.

This study evaluated an image processing method for assessing liver fibrosis using conventional CT scans in patients with chronic hepatitis C. Two cohorts of chronic hepatitis C patients -- designated the "estimation" (n = 34) and "validation" (n = 107) groups -- were assessed using digitized conventional helical CT imaging.

Weighted CT mean fibrosis ("Fibro-CT") was calculated as a non-linear weighted mean F-score for each sample. Histological fibrosis based on biopsies was diagnosed on a scale of F0 to F4 by 2 pathologists blinded with regard to the Fibro-CT data.

Results

• Fibrosis according to Fibro-CT correlated with histology-determined fibrosis (r = 0.69; P < 0.001) and with increasing fibrosis stage:
• F0 = 0.23 +/- 0.39;
• F1 = 0.90 +/- 0.99;
• F2 = 1.41 +/- 0.94;
• F3 = 2.79 +/- 0.55;
• F4 = 3.15 +/- 0.35 (ANOVA P < 0.0001).
• The receiver operating characteristics (ROC) curve was 0.83 to diagnose significant fibrosis (? F2) and 0.86 to diagnose advanced fibrosis (? F3).

• The correlation between Fibro-CT and histologically determined fibrosis was higher in patients with homogeneous distribution of fibrosis throughout the liver than in patients with heterogeneous distribution (r = 0.77 vs 0.43; P < 0.05).

Conclusion

Based on these findings, the authors concluded, "Optical digital analysis of CT images of the liver is effective in determining the stage and distribution of liver fibrosis in chronic hepatitis C."

"Fibro-CT is a simple to use, readily available, and useful method for the diagnosis of fibrosis in patients with chronic hepatitis C," they added.

Unit for the Clinical Management of Digestive Diseases and CIBEREHD, Hospital Universitario de Valme, Sevilla, Spain; Department of Applied Physics III, ESI-University of Seville, Spain; Hospital Central de Asturias, Oviedo, Spain; Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain; Fundación Hospital Alcorcón, Madrid, Spain; Hospital Universitario de Valme, Sevilla, Spain; Hospital del Mar, Barcelona, Spain; Hospital Universitario de Puerto Real, Cádiz, Spain; Hospital Costa del Sol, Marbella, Málaga, Spain; Hospital Virgen de la Victoria, Málaga, Spain; Hospital Universitario "San Cecilio, Granada, Spain; Hospital General Universitario de Valencia, Valencia, Spain.

01/15/08

Reference
M Romero-Gomez, E Gomez-Gonzalez, A Madrazo, and others. Optical analysis of computed tomography images of the liver predicts fibrosis stage and distribution in chronic hepatitis C. Hepatology. December 20, 2007 [Epub ahead of print].

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