title: Liver Surface Nodularity Quantification from Routine CT Images as a Biomarker for Detection and Evaluation of Cirrhosis.
abstract: Purpose To determine the accuracy, reproducibility, and intra- and interobserver agreement of a computer-based quantitative method to measure liver surface nodularity (LSN) from routine computed tomographic (CT) images as a biomarker for detection and evaluation of cirrhosis. Materials and Methods For this institutional review board-approved HIPAA-compliant retrospective study, adult patients with healthy livers (n = 24) or various stages of hepatitis C virus-induced chronic liver disease (n = 70) with routine nonenhanced and portal venous phase contrast agent-enhanced liver CT imaging with thick-section (5.0 mm) and thin-section (1.25-1.50 mm) axial images obtained between January 1, 2006, and March 31, 2011, were identified from the electronic medical records. A computer algorithm was developed to measure LSN and derive a score. LSN scores, splenic volume, and the ratio of left lateral segment (LLS) to total liver volume (TLV) were measured from the same multiphasic liver CT examinations. Accuracy for differentiating cirrhotic from noncirrhotic livers was assessed by area under the receiver operating characteristic curve. Intra- and interobserver agreement was assessed by intraclass correlation coefficient. Results Median LSN scores from nonenhanced thick-section CT images in cirrhotic livers (3.16; 56 livers) were significantly higher than in noncirrhotic livers (2.11; 38 livers; P < .001). LSN scores from the four CT imaging types (94 patients for each type) were very strongly correlated (range of Spearman r, 0.929-0.960). LSN scores from portal venous phase contrast-enhanced thick-section CT images had significantly higher accuracy (area under the receiver operating characteristic curve, 0.929) than splenic volume (area under the receiver operating characteristic curve, 0.835) or LLS-to-TLV ratio measurements (area under the receiver operating characteristic curve, 0.753) for differentiating cirrhotic from noncirrhotic livers (P = .038 and .003, respectively; n = 94). Intra- and interobserver agreements that used nonenhanced thick CT images were very good (intraclass correlation coefficient, 0.963 and 0.899, respectively). Conclusion Quantitative measurement of LSN on routine CT images accurately differentiated cirrhotic from noncirrhotic livers and was highly reproducible. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Cody R
authors.initials: CR
authors.lastname: Branch
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Kevin
authors.initials: K
authors.lastname: Zand
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Charu
authors.initials: C
authors.lastname: Subramony
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Haowei
authors.initials: H
authors.lastname: Zhang
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Katherine
authors.initials: K
authors.lastname: Thaggard
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Richard
authors.initials: R
authors.lastname: Hosch
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Jason
authors.initials: J
authors.lastname: Bryan
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Amit
authors.initials: A
authors.lastname: Vasanji
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Michael
authors.initials: M
authors.lastname: Griswold
authors.affiliation: From the Department of Radiology (A.D.S., C.R.B., K.Z., H.Z., K.T., R.H.), Department of Pathology (C.S.), and Center for Biostatistics and Bioinformatics (M.G., X.Z.), University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216; and ImageIQ, Cleveland, Ohio (J.B., A.V.).
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D015415:Biomarkers; D003287:Contrast Media; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D015415:Biomarkers; D003287:Contrast Media