Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 988-996
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.988
Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices
Hang Li, Tian-Wu Chen, Zhen-Lin Li, Xiao-Ming Zhang, Cheng-Jun Li, Xiao-Li Chen, Guang-Wen Chen, Jia-Ni Hu, Yong-Quan Ye
Hang Li, Tian-Wu Chen, Xiao-Ming Zhang, Cheng-Jun Li, Xiao-Li Chen, Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Hang Li, Guang-Wen Chen, Department of Radiology, Sichuan Provincial People’s Hospital, Chengdu 610070, Sichuan Province, China
Zhen-Lin Li, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Jia-Ni Hu, Yong-Quan Ye, Department of Radiology, Wayne State University, Detroit, MI 48201, United States
Author contributions: Li H, Li ZL, Zhang XM and Li CJ contributed equally to this work; Li H, Chen TW, Chen XL, Li ZL, Zhang XM and Li CJ designed the research; Li H, Chen XL, Chen GW, Hu JN and Ye YQ performed the research; Li H, Chen TW, Li ZL, Chen XL, Chen GW, Hu JN and Ye YQ contributed new reagents/analytic tools; Li H, Chen XL and Chen TW analyzed the data; Li H, Chen TW and Chen XL wrote the paper.
Supported by National Natural Science Foundation of China, No. 81050033; Key Projects in the Sichuan Province Science and Technology Pillar Program, No. 2011SZ0237; the Science Foundation for Distinguished Young Scholars of Sichuan Province in China, No. 2010JQ0039; Key Science and Technology Project of Chinese Ministry of Public Health, No. 2014114; and Natural Science Key Project of North Sichuan Medical College, No. CBY12-A-ZD03.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tian-Wu Chen, MD, Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China. chentw@aliyun.com
Telephone: +86-817-2262236 Fax: +86-817-2262236
Received: July 18, 2014
Peer-review started: July 20, 2014
First decision: August 27, 2014
Revised: September 11, 2014
Accepted: October 20, 2014
Article in press: October 21, 2014
Published online: January 21, 2015
Processing time: 186 Days and 2.4 Hours
Abstract

AIM: To investigate whether liver lobe volume and albumin (ALB) could predict the presence and severity of liver cirrhosis, and esophageal varices.

METHODS: Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study. All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume, and biochemical workup for testing ALB and Child-Pugh class. All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices. Right liver lobe volume (RV), left medial liver lobe volume (LMV), left lateral liver lobe volume (LLV), and caudate lobe volume (CV) were measured using enhanced magnetic resonance imaging. The ratios of RV to ALB (RV/ALB), LMV to ALB (LMV/ALB), LLV to ALB (LLV/ALB) and CV to ALB (CV/ALB) were calculated. Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis, and the presence of esophageal varices.

RESULTS: RV, LMV, LLV and CV decreased (r = -0.51-0.373; all P < 0.05), while RV/ALB increased (r = 0.424; P < 0.05), with the progress of Child-Pugh class of liver cirrhosis. RV, LMV, CV, LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV, LMV, LLV, CV, RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV, RV/ALB and CV/ALB could identify presence of esophageal varices (all P < 0.05). Among these parameters, CV/ALB could best identify the presence of liver cirrhosis, with an area under receiver operating characteristic curve (AUC) of 0.860, a sensitivity of 82.0% and a specificity of 83.0%. LLV could best distinguish class A from B, with an AUC of 0.761, a sensitivity of 74.4% and a specificity of 73.1%. RV could best distinguish class A from C, with an AUC of 0.900, a sensitivity of 90.3% and a specificity of 84.5%. LLV/ALB could best distinguish class B from C, with an AUC of 0.900, a sensitivity of 93.8% and a specificity of 81.5%. RV/ALB could best identify esophageal varices, with an AUC of 0.890, a sensitivity of 80.0% and a specificity of 83.5%.

CONCLUSION: The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis, and presence of esophageal varices.

Keywords: Magnetic resonance imaging; Liver cirrhosis; Liver lobe volume; Esophageal varices; Child-Pugh class

Core tip: We determined whether and how the combination of albumin and liver lobe volume (measured using magnetic resonance imaging) could predict the presence and severity of liver cirrhosis, and the presence of esophageal varices. The ratio of caudate lobe volume to albumin could identify the occurrence of cirrhosis, and that of left lateral liver lobe volume, right liver lobe volume, and the ratio of left lateral liver lobe volume to albumin could differentiate Child-Pugh class A from B, A from C, and B from C, respectively. The right liver lobe volume to albumin ratio could identify the presence of esophageal varices.