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Diagnosis of Cirrhosis by Spiral Computed Tomography: A Case-Control Study With Feature Analysis and Assessment of Interobserver Agreement

Keedy, Alexander BS; Westphalen, Antonio C. MD; Qayyum, Aliya MBBS; Aslam, Rizwan MBBS; Rybkin, Alexander V. MD; Chen, Mei-Hsiu PhD; Coakley, Fergus V. MD, MB, BCh

Journal of Computer Assisted Tomography: March-April 2008 - Volume 32 - Issue 2 - p 198-203
doi: 10.1097/RCT.0b013e31815ea857
Abdominal Imaging: Original Article

Purpose: To determine the accuracy and interobserver agreement of spiral computed tomography (CT) in the diagnosis of cirrhosis.

Materials and Methods: We retrospectively identified 126 patients who underwent spiral CT at our institution and who had a contemporaneous histopathologic confirmation of cirrhosis (n = 67) or clinical and biochemical evidence of a normal liver (n = 59). Two experienced readers independently recorded the overall likelihood of cirrhosis and the presence or absence of hepatic and extrahepatic findings of cirrhosis and portal hypertension on a 5-point scale from 1 (definitely absent) to 5 (definitely present/severe).

Results: Receiver operating characteristic curve and κ statistic analyses showed that the overall likelihood of cirrhosis was the most accurate and objective observation, with an area under the curve (AUC) of 0.97 for reader 1 and 0.90 for reader 2 and a κ value of 0.70. Individual findings that were accurate and objective were diaphragmatic surface nodularity (AUC = 0.95 and 0.88 for readers 1 and 2, respectively, κ = 0.75), global or segmental volume loss (AUC = 0.95 and 0.87 for readers 1 and 2, respectively, κ = 0.70), and superior diaphragmatic adenopathy (AUC = 0.85 for both readers, κ = 0.78). Of note, portal vein diameter was not significantly different between normal and cirrhotic patients as measured by either reader (P = 0.54 and 0.65).

Conclusion: Spiral CT demonstrates high accuracy and interobserver agreement in the diagnosis of cirrhosis, suggesting CT may be a supplementary diagnostic test in patients who have contraindications to biopsy or have equivocal biopsy findings.

From the Department of Radiology, University of California, San Francisco, San Francisco, CA.

Received for publication July 19, 2007; accepted October 11, 2007.

Reprints: Fergus V. Coakley, MD, MB, BCh, Abdominal Imaging, University of California, San Francisco, Box 0628, M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628 (e-mail:

Scientific presentation at the American Roentgen Ray Society 106th Annual Meeting, Vancouver, British Columbia, Canada, 2006.

© 2008 Lippincott Williams & Wilkins, Inc.