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An Elevated Arterial Enhancement Fraction Is Associated With Clinical and Imaging Indices of Liver Fibrosis and Cirrhosis

Bonekamp, David MD, PhD; Bonekamp, Susanne DVM, PhD; Geiger, Bernhard PhD; Kamel, Ihab R. MD, PhD

Journal of Computer Assisted Tomography: November/December 2012 - Volume 36 - Issue 6 - p 681–689
doi: 10.1097/RCT.0b013e3182702ee3

Objective The objective of this study was to determine whether arterial enhancement fraction (AEF) is associated with the degree of liver fibrosis and cirrhosis in patients with chronic liver disease.

Methods Sixty-five patients (mean age, 55.8 years; 19 female patients) underwent triple-phase computed tomography scanning. Mean AEF was determined for the left and right hepatic lobe of the liver using a prototypical software module and compared between groups of different liver fibrosis grade.

Results Mean AEF was higher in patients with liver disease compared with those without liver disease. Mean AEF differed significantly between patients with normal liver or mild fibrosis (category 1), moderate to severe fibrosis (category 2), and cirrhosis (category 3). Receiver operating characteristic curve analysis determined an area under the curve of 0.79/0.78, with an optimal cutoff for mean AEF of 9.2/16.8, for differentiating between category 2 or higher/category 3 disease.

Conclusions The mean hepatic AEF can provide an accurate, fast, noninvasive assessment of the degree of fibrosis in chronic liver disease.

From the *Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD; and †Siemens Corporate Research Princeton Inc, Princeton NJ.

Received for publication July 2, 2012; accepted August 21, 2012.

Reprints: Ihab R. Kamel, MD, PhD, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 600 N Wolfe St, MRI 143, Baltimore, MD 21287 (e-mail:

Dr Kamel is receiving grant support from Bracco Diagnostics, Bayer Healthcare, and Siemens Medical. Dr S. Bonekamp is receiving salary support from Bracco Diagnostics, Bayer Healthcare, and Siemens Medical. Dr Geiger is an employee of Siemens Corporate Research. The authors (Drs D. Bonekamp, S. Bonekamp, and Kamel) who are not employees of Siemens had full control of inclusion, statistical analysis, and publication of the data at all times. For Dr Bonekamp, no conflicts of interest or sources of funding were declared.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.