Usefulness of Hepatic CT Attenuation Values in Assessment of Fontan-Associated Liver Disease Progression: A Comparative Study with MELD-XI Scores

Abstract

Background Fontan-associated liver disease (FALD) leads to liver cirrhosis and carcinoma, worsening patient prognosis. While the Model of End-Stage Liver Disease Excluding INR (MELD-XI) score correlates with FALD severity, precise prediction methods remain elusive. The hepatic computed tomography (CT) attenuation is used to assess steatohepatitis, which may offer insight into FALD progression. This study aimed to determine the usefulness of hepatic CT attenuation values in assessing FALD progression. Methods All data of post-Fontan patients at our institution between 1980 and 2021 were reviewed. Patients with postoperative abdominal CT data followed up for > 20 years postoperatively were included. We set five regions of interest with a 20-mm-diameter circle in the peripheral region of the liver to obtain minimum, maximum, mean, and standard deviation (SD) of the liver CT attenuation values. The values were indexed by that of the aorta (aV_MIN, aV_MAX, and aV_MEAN). The impact of liver CT attenuation values on cirrhosis development diagnosed by liver biopsy was evaluated. Results In total, 30 patients were included, 9 of whom developed cirrhosis. In the Cox regression model, significantly associated factors for cirrhosis were aV_MIN, aV_MAX, SD, and MELD-XI scores. aV_MIN and SD were correlated with concomitant MELD-XI scores. In cirrhosis patients, aV_MIN and SD showed longitudinal alteration before cirrhosis, while MELD-XI scores remained stable. Conclusion The hepatic CT attenuation values were associated with cirrhosis development. Changes in the hepatic CT attenuation are more sensitive to FALD progression than the MELD-XI score.