Liver segmental volume and attenuation ratio (LSVAR) on portal venous CT scans improves the detection of clinically significant liver fibrosis compared to liver segmental volume ratio (LSVR).

BACKGROUND: The aim of this proof-of-concept study was to show that the liver segmental volume and attenuation ratio (LSVAR) improves the detection of significant liver fibrosis on portal venous CT scans by adding the liver vein to cava attenuation (LVCA) to the liver segmental volume ratio (LSVR). MATERIAL AND METHODS: Patients who underwent portal venous phase abdominal CT scans and MR elastography (reference standard) within 3 months between 02/2016 and 05/2017 were included. The LSVAR was calculated on portal venous CT scans as LSVR*LVCA, while the LSVR represented the volume ratio between Couinaud segments I-III and IV-VIII, and the LVCA represented the density of the liver veins compared to the density in the vena cava. The LSVAR and LSVR were compared between patients with and without significantly elevated liver stiffness (based on a cutoff value of 3.5 kPa) using the Mann-Whitney U test and ROC curve analysis. RESULTS: The LSVR and LSVAR allowed significant differentiation between patients with (n = 19) and without (n = 122) significantly elevated liver stiffness (p < 0.001). However, the LSVAR showed a higher area under the curve (AUC = 0.96) than the LSVR (AUC = 0.74). The optimal cutoff value was 0.34 for the LSVR, which detected clinically increased liver stiffness with a sensitivity of 53% and a specificity of 88%. With a cutoff value of 0.67 for the LSVAR, the sensitivity increased to 95% while maintaining a specificity of 89%. CONCLUSION: The LSVAR improves the detection of significant liver fibrosis on portal venous CT scans compared to the LSVR.

[Delirious psychiatric nurse with abdominal pain - a medical chameleon]. / Deliranter Psychiatriepfleger mit Bauchschmerzen - Ein medizinisches Chamäleon.

Acute hepatic porphyrias stand for a group of rare genetic defects in the metabolism of heme biosynthesis, whereof acute intermittent porphyria is the most frequent one. Factors like drugs, infections, fasting, alcohol, or stress can provoke an acute crisis. The symptoms are very variable; however gastrointestinal and neuro-psychiatric symptoms are common. Furthermore darkening urine might be an important diagnostic sign. We describe the case of a 33-year-old psychiatric nurse presenting with stomach ache, hypertension, delirium and red spots in his underwear.