Diagnosis of cirrhosis by spiral computed tomography: A case-control study with feature analysis and assessment of interobserver agreement

Purpose: To determine the accuracy and interobserver agreement of spiral computed tomography (CT) in the diagnosis of cirrhosis. Materials and Methods: We retrospectively identified 126 patients who underwent spiral CT at our institution and who had a contemporaneous histopathologic confirmation of cirrhosis (n = 67) or clinical and biochemical evidence of a normal liver (n = 59). Two experienced readers independently recorded the overall likelihood of cirrhosis and the presence or absence of hepatic and extrahepatic findings of cirrhosis and portal hypertension on a 5-point scale from 1 (definitely absent) to 5 (definitely present/severe). Results: Receiver operating characteristic curve and K statistic analyses showed that the overall likelihood of cirrhosis was the most accurate and objective observation, with an area under the curve (AUC) of 0.97 for reader 1 and 0.90 for reader 2 and a K value of 0.70. Individual findings that were accurate and objective were diaphragmatic surface nodularity (AUC = 0.95 and 0.88 for readers 1 and 2, respectively, K = 0.75), global or segmental volume loss (AUC = 0.95 and 0.87 for readers 1 and 2, respectively, K = 0.70), and superior diaphragmatic adenopathy (AUC = 0.85 for both readers, K = 0.78). Of note, portal vein diameter was not significantly different between normal and cirrhotic patients as measured by either reader (P = 0.54 and 0.65). Conclusion: Spiral CT demonstrates high accuracy and interobserver agreement in the diagnosis of cirrhosis, suggesting CT may be a supplementary diagnostic test in patients who have contraindications to biopsy or have equivocal biopsy findings.