Detection of fatty liver using virtual non-contrast dual-energy CT

PURPOSE: Determine whether liver attenuation measured on dual-energy CT (DECT) virtual non-contrast examinations predicts the presence of fatty liver. METHODS: Single-institution retrospective review from 2016 to 2020 found patients with DECT and proton density fat fraction MRI (MRI PDFF) within 30 days. MRI PDFF was the reference standard for determining hepatic steatosis. Attenuation measurements from VNC and mixed 120 kVp-like images were compared to MRI PDFF in the right and left lobes. Performance of VNC was compared to measurement of the liver-spleen attenuation difference (LSAD). RESULTS: 128 patients were included (69 men, 59 women) with mean age 51.6 years (range 14–98 years). > 90% of patients received CT and MRI in the emergency department or as inpatients. Median interval between DECT and MRI PDFF was 2 days (range 0–28 days). Prevalence of fatty liver using the reference standard (MRI PDFF > 6%) was 24%. Pearson correlation coefficient between VNC and MRI- DFF was -0.64 (right) and -0.68 (left, both p < 0.0001). For LSAD, correlation was − 0.43 in both lobes (p < 0.0001). Considering MRI PDFF > 6% as diagnostic of steatosis, area under the receiver operator characteristic curve (AUC) was 0.834 and 0.872 in the right and left hepatic lobes, with an optimal threshold of 54.8 HU (right) and 52.5 HU (left), yielding sensitivity/specificity of 57%/93.9% (right) and 67.9%/90% (left). For LSAD, AUC was 0.808 (right) and 0.767 (left) with optimal sensitivity/specificity of 93.3%/57.1% (right) and 78.6%/68% (left). CONCLUSION: Attenuation measured at VNC CT was moderately correlated with liver fat content and had > 90% specificity for diagnosis of fatty liver. GRAPHICAL ABSTRACT: [Image: see text]