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

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

doi:10.3389/fmed.2023.1118531

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

Front Med (Lausanne). 2023 Mar 22:10:1118531. doi: 10.3389/fmed.2023.1118531. eCollection 2023.

Authors

Amritjyot Kaur¹, Nipun Verma², Baljinder Singh¹, Ajay Kumar¹, Sunita Kumari², Arka De², Ratti Ram Sharma³, Virendra Singh²

Affiliations

¹ Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
³ Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

Background: 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).

Methods: 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).

Results: 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 (r = -0.728, p < 0.001), MELD (r = -0.743; p < 0.001) and ICG-R-15 (r = -0.720, p < 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, p = 0.001) and improvement in CTP/MELD correlated with better survival of G-CSF treated DC patients (p < 0.05). SMT did not show any improvement in Q-SPECT/CT or clinical severity scores (p > 0.05). %QLU > 25 (adj.H.R.: 0.234, p = 0.003) and G-CSF treatment (adj.H.R.: 0.414, p = 0.009) were independent predictors of better 12-months survival in DC.

Conclusion: Q-SPECT/CT (%QLU) is a novel non-invasive, diagnostic, prognostic, and theragnostic marker of liver reserve and its functions in cirrhosis patients.

Clinical trial registration: Clinicaltrials.gov, NCT02451033 and NCT03415698.

Keywords: G-CSF; SPECT; decompensated cirrhosis; imaging; mortality.

Associated data

ClinicalTrials.gov/NCT02451033
ClinicalTrials.gov/NCT03415698