Automated measurement of liver attenuation to identify moderate-to-severe hepatic steatosis from chest CT scans

Eur J Radiol. 2020 Jan:122:108723. doi: 10.1016/j.ejrad.2019.108723. Epub 2019 Oct 25.

Abstract

Purpose: Develop and validate an automated method for measuring liver attenuation in non-contrast low-dose chest CT (LDCT) scans and compare it to the standard manual method for identifying moderate-to-severe hepatic steatosis (HS).

Method: The automated method identifies a region below the right lung within the liver and uses statistical sampling techniques to exclude non-liver parenchyma. The method was used to assess moderate-to-severe HS on two IRB-approved cohorts: 1) 24 patients with liver disease examined between 1/2013-1/2017 with non-contrast chest CT and abdominal MRI scans obtained within three months of liver biopsy, and 2) 319 lung screening participants with baseline LDCT performed between 8/2011-1/2017. Agreement between the manual and automated CT methods, the manual MRI method, and pathology for determining moderate-to-severe HS was assessed using Cohen's Kappa by applying a 40 HU threshold to the CT method and 17.4% fat fraction to MRI. Agreement between the manual and automated CT methods was assessed using the intraclass correlation coefficient (ICC). Variability was assessed using Bland-Altman limits of agreement (LoA).

Results: In the first cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.97, κ = 1.00) with LoA of -7.6 to 4.7 HU. Both manual and automated CT methods had almost perfect agreement with MRI (κ = 0.90) and substantial agreement with pathology (κ = 0.77). In the second cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.94, κ = 0.87). LoA were -10.6 to 5.2 HU.

Conclusion: Automated measurements of liver attenuation from LDCT scans can be used to identify moderate-to-severe HS on LDCT.

Keywords: Hepatic steatosis; Image analysis; Low-dose CT; Lung screening.

Publication types

  • Comparative Study

MeSH terms

  • Fatty Liver / diagnostic imaging*
  • Female
  • Humans
  • Lung / diagnostic imaging
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Prospective Studies
  • Reproducibility of Results
  • Tomography, X-Ray Computed / methods