AUTHOR=Kaur Amritjyot , Verma Nipun , Singh Baljinder , Kumar Ajay , Kumari Sunita , De Arka , Sharma Ratti Ram , Singh Virendra 

TITLE=Quantitative liver SPECT/CT is a novel tool to assess liver function, prognosis, and response to treatment in cirrhosis

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1118531

DOI=10.3389/fmed.2023.1118531

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>Functional liver reserve is an important determinant of survival in cirrhosis. The traditional indocyanine green test (ICG) is cumbersome. Hence, we developed and validated a novel liver imaging, a hybrid of SPECT and CT (Q-SPECT/CT), for evaluating disease severity, outcomes, and response to treatment in decompensated cirrhosis (DC).</p></sec><sec><title>Methods</title><p>We recruited a cohort of DC patients at a tertiary institute between 2016–2019. First, we standardized the Q-SPECT/CT across a predefined range of volumes through phantom experiments. Then we performed clinical and laboratory evaluations, ICG test (retention at 15 min), and Q-SPECT/CT at baseline and 12 months of granulocyte colony-stimulating factor (G-CSF) and standard medical treatment (SMT).</p></sec><sec><title>Results</title><p>In 109 DC patients, 87.1% males, aged 51 ± 10 years, MELD: 14 (7–21), the percent quantitative liver uptake (%QLU) on Q-SPECT/CT exhibited a strong correlation with CTP (<italic>r</italic> = −0.728, <italic>p</italic> &lt; 0.001), MELD (<italic>r</italic> = −0.743; p &lt; 0.001) and ICG-R-15 (<italic>r</italic> = −0.720, p &lt; 0.001) at baseline. %QLU had the maximum discrimination (AUC: 0.890–0.920), sensitivity (88.9–90.3%), specificity (81.2–90.7%), and accuracy (85.8–89.4%) than liver volumes on Q-SPECT/CT or ICG test for classifying patients in CTP/MELD based prognostic categories. A significant increase in %QLU (26.09 ± 10.06 to 31.2 ± 12.19, <italic>p</italic> = 0.001) and improvement in CTP/MELD correlated with better survival of G-CSF treated DC patients (<italic>p</italic> &lt; 0.05). SMT did not show any improvement in Q-SPECT/CT or clinical severity scores (<italic>p</italic> &gt; 0.05). %QLU &gt; 25 (adj.H.R.: 0.234, <italic>p</italic> = 0.003) and G-CSF treatment (adj.H.R.: 0.414, <italic>p</italic> = 0.009) were independent predictors of better 12-months survival in DC.</p></sec><sec><title>Conclusion</title><p>Q-SPECT/CT (%QLU) is a novel non-invasive, diagnostic, prognostic, and theragnostic marker of liver reserve and its functions in cirrhosis patients.</p></sec><sec><title>Clinical trial registration</title><p><ext-link xlink:href="https://www.clinicaltrials.gov/" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">Clinicaltrials.gov</ext-link>, NCT02451033 and NCT03415698.</p></sec>