Multiparametric Dual-Energy CT for ALBI-Based Liver Function Stratification in Cirrhosis: Diagnostic Accuracy and Clinical Utility

OBJECTIVE: This study aims to investigate the diagnostic value of dual-energy computed tomography (DECT)-derived quantitative imaging parameters, including arterial iodine fraction (AIF), extracellular volume fraction (fECV), and iodine washout rate (IWR), in the assessment of liver function grading in patients with cirrhosis, to identify the optimal diagnostic parameters. METHODS: We collected DECT data from 68 patients with cirrhosis and 25 healthy controls at our institution and used the albumin-bilirubin (ALBI) scoring system for liver function grading. DECT images were processed for iodine quantification, and AIF, fECV, and IWR parameters were calculated. The correlation between DECT iodine parameters and ALBI grading was analyzed using the Spearman correlation coefficient; independent-sample t tests or nonparametric Mann-Whitney U tests were used to compare the differences in parameters between the cirrhosis group and the normal control group. The nonparametric Kruskal-Wallis H test was used to compare DECT iodine parameters across different ALBI groups within the cirrhosis cohort. The diagnostic efficacy of the iodine parameters in discriminating different ALBI grades was analyzed using the receiver operating characteristic (ROC) curve. RESULTS: Significant correlations were observed between AIF, fECV, and IWR with ALBI grades ( r =0.873, 0.908, and -0.846, respectively; all P <0.001). In the cirrhosis group, AIF, fECV, and IWR exhibited statistically significant differences across ALBI grades (all P <0.001). The AUC values of fECV for distinguishing Control versus ALBI1+2+3, ALBI1 versus ALBI2+3, and ALBI1+2 versus ALBI3 were 0.955 (0.918 to 0.993), 0.945 (0.900 to 0.994), and 0.974 (0.942 to 1.000), respectively, with corresponding optimal cutoff values of 27.41%, 29.34%, and 35.40%, the diagnostic effect was better than AIF and IWR. CONCLUSION: DECT-derived AIF, fECV, and IWR effectively assess liver function in cirrhosis through ALBI grading, with fECV showing superior standalone performance; multiparametric integration enhances diagnostic accuracy.