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Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex: Objective Classification Using a Contemporary Cohort.

Publication ,  Journal Article
Wildman-Tobriner, B; Enslow, MS; Nelson, RC
Published in: Curr Probl Diagn Radiol
2019

OBJECTIVE: When objectively measured on computed tomography (CT), does hepatic heterogeneity or overall liver attenuation predict the presence of shock? METHODS: This retrospective study included 73 patients (mean age 33 years) with the hypoperfusion shock complex (HSC) on CT (cases) and 100 patients (mean age 43 years) with negative trauma CT scans (controls). Liver heterogeneity was calculated by using consistently sized regions of interest (ROIs) to measure the 2 highest and the 2 lowest areas of hepatic density (in Hounsfield units [HU]). The difference between the means of the 2 highest and 2 lowest ROIs was considered the heterogeneity. Attenuation was calculated using the mean of 3 randomly placed ROIs. Both heterogeneity and attenuation were then compared between cases and controls. RESULTS: Median hepatic heterogeneity was 16.8 HU (IQR: 10.7-23.4) for the HSC group and 9.0 HU (IQR: 7.0-10.4) for the controls (P < 0.001). The area under the curve was 0.79, and a threshold of 30 HU yielded a specificity of 100%. Median hepatic attenuation was not significantly different between the HSC and the control groups, with an area under the curve of 0.56. CONCLUSIONS: Increased hepatic heterogeneity may represent an objective marker of the HSC that performs in a similar manner to other established signs. By comparison, overall hepatic hypoattenuation is a poor indicator of the HSC.

Duke Scholars

Published In

Curr Probl Diagn Radiol

DOI

EISSN

1535-6302

Publication Date

2019

Volume

48

Issue

3

Start / End Page

224 / 228

Location

United States

Related Subject Headings

  • Wounds, Nonpenetrating
  • Tomography, X-Ray Computed
  • Shock
  • Retrospective Studies
  • Radiography, Abdominal
  • Radiographic Image Interpretation, Computer-Assisted
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Liver
 

Citation

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Wildman-Tobriner, B., Enslow, M. S., & Nelson, R. C. (2019). Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex: Objective Classification Using a Contemporary Cohort. Curr Probl Diagn Radiol, 48(3), 224–228. https://doi.org/10.1067/j.cpradiol.2018.02.004
Wildman-Tobriner, Benjamin, Michael S. Enslow, and Rendon C. Nelson. “Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex: Objective Classification Using a Contemporary Cohort.Curr Probl Diagn Radiol 48, no. 3 (2019): 224–28. https://doi.org/10.1067/j.cpradiol.2018.02.004.
Wildman-Tobriner, Benjamin, et al. “Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex: Objective Classification Using a Contemporary Cohort.Curr Probl Diagn Radiol, vol. 48, no. 3, 2019, pp. 224–28. Pubmed, doi:10.1067/j.cpradiol.2018.02.004.
Journal cover image

Published In

Curr Probl Diagn Radiol

DOI

EISSN

1535-6302

Publication Date

2019

Volume

48

Issue

3

Start / End Page

224 / 228

Location

United States

Related Subject Headings

  • Wounds, Nonpenetrating
  • Tomography, X-Ray Computed
  • Shock
  • Retrospective Studies
  • Radiography, Abdominal
  • Radiographic Image Interpretation, Computer-Assisted
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Liver