The functional liver volume (fLV) by HEPATIQ is superior to ATI in the diagnosis of steatohepatitis

Introduction: The functional liver volume (fLV) can only be measured by the SPECT analysis of the Tc99 sulfur colloid quantitative liver spleen scan (QLSS). HEPATIQ is a program that facilitates processing of these images on a routine basis. Although there is a good correlation of fLV with the anatomic liver volume by MRI/CT in non-cirrhotic patients (Everson GT, 2013 Liver Transplantation 19: 292), only HEPATIQ measurements are valid in the setting of cirrhosis or infiltrating masses in which there is a good correlation with the functional mass of the liver (Am J of Gastro 1997;92:2054.). The fLV enlarges in the setting of fatty infiltration, but has not been investigated as a diagnostic tool for steatohepatitis (SH) from either alcohol (alcoholic steatohepatitis = ASH) or non-alcoholic steatohepatitis (NASH). Attenuation imaging (ATI) is an ultrasound (US) based test that is a reliable measure of liver fat and has been used in the diagnosis of NASH (Dong Ho Lee; 2021: J Medical Ultrasonics 48:465). We compared the diagnostic ability of fLV vs ATI in the diagnosis of steatohepatitis in a general hepatology population.

Methods: 251 consecutive patients of multiple unselected causes were evaluated by SPECT QLSS for functional liver volume (fLV), perfused hepatic mass (PHM), functional spleen volume (fSV) and hepatic activity index (HAI). US with ATI was obtained. The clinical diagnosis 251 of NASH was based on predisposing factors, fatty infiltration by CT or MRI and liver biopsy.

Results: ASH was present in 21 patients and NASH in 47. The rest of the patients had CHC 21, CHB 44, autoimmune liver disease 25, cryptogenic cirrhosis 7, abnormal liver tests 38, liver transplant 11 and miscellaneous 37. 35 had a liver biopsy. ASH and NASH were combined under SH (68 patients). We compared the ability of ATI and fLV to diagnose steatohepatitis (figure). The AUC for fLV was 0.774 and for ATI 0.688.

Conclusions: 1. fLV is superior to ATI in the diagnosis of steatohepatitis. 2. The diagnostic value of fLV over ATI suggests there are other causes of hepatic enlargement in addition to fat and measuring fat alone may not be sufficient to identify or follow most cases of steatohepatitis. 3. The unique ability of HEPATIQ to measure the fLV suggests it should have a prominent role in the assessment and following of these patients.

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