Search Results (98)

Cardiac magnetic resonance (CMR) imaging has been considered crucial in non-ischemic cardiomyopathy (NICM). This study aims to evaluate the role of CMR in identifying risk factors for life-threatening events in patients with NICM and reduced left ventricular ejection fraction (LVEF). Methods: We analysed 57 (mean age 62.5 ± 11.4 years, 68.4% male) first-diagnosed NICM patients with reduced LVEF (mean 42 ± 9%). CMR assessments evaluated LVEF, right ventricular ejection fraction (RVEF), cardiac T1 mapping, extracellular volume (ECV), and the presence/extension of late gadolinium enhancement (LGE). Patients were monitored for a composite endpoint including sudden cardiac death (SCD), major ventricular arrhythmic events, and hospitalization for heart failure (HHF). Results: During a median follow-up lasting 543 days, 18 patients (31%) experienced cardiovascular events. A higher native T1 mapping value (1076 (1025–1120) ms vs. 999 (990–1037) ms, p < 0.001), a higher ECV (34 ± 6% vs. 28 ± 4,% p < 0.001) and a reduced RVEF (52 ± 13% vs. 60 ± 9%, p < 0.03) proved to be significantly correlated to an increased HHF, arrhythmic and SCD risk. Additionally, a native T1 mapping value exceeding 1018 ms demonstrated an increased risk (HR: 6.285; 95% CI: 2.044–19.326, p = 0.001) as well as an ECV greater than 28% (HR: 19.752; 95% CI: 2.622–148.817, p = 0.004) for composite endpoint. Conclusion: In NICM patients, elevated native T1 mapping and ECV values identified a high-risk subgroup for arrhythmic events while LVEF, and RVEF provide further risk stratification for the composite endpoint. CMR assessment may optimize risk stratification in NICM patients. Full article

Background/Objectives: Preoperative differentiation between oral squamous cell carcinoma (SCC) and minor salivary gland carcinoma (SGC) remains clinically challenging due to overlapping imaging characteristics. This study aimed to develop a diagnostic model based on quantitative dynamic contrast-enhanced MRI (qDCE-MRI) parameters to distinguish SCC from SGC prior to surgery. Methods: Patients with histopathologic confirmed SCC or minor SGC who underwent preoperative 3.0T qDCE-MRI were recruited. Clinical characteristics and pharmacokinetic parameters, including volume transfer constant (K^trans), reverse reflux rate constant (K_ep), volume fraction of extravascular extracellular space (V_e), plasma volume fraction (V_p), time to peak (TTP), maximum concentration (MAXConc), maximal slope (MAXSlope), and area under the concentration-time curve (AUCt), along with the apparent diffusion coefficient (ADC), were extracted. Univariate and multivariable logistic regression analyses were performed to identify independent discriminators. Diagnostic performance was assessed using receiver operating characteristic analysis, and model comparisons were conducted with the DeLong test. Interobserver agreement was evaluated using intraclass correlation coefficients (ICC). Results: All qDCE-MRI parameters demonstrated excellent interobserver agreement (ICC range, 0.82–0.94). Multivariable analysis identified K_ep (OR = 2620.172, p = 0.001), maximal slope (OR = 1.715, p = 0.024), and tumor location (OR = 5.561, p = 0.027) as independent predictors. The qDCE-MRI model achieved superior diagnostic performance compared with the clinical model (AUC: 0.945 vs. 0.747; p = 0.012). Conclusions: A qDCE-MRI–based model incorporating K_ep and MAXSlope was shown to provide excellent accuracy for preoperative differentiation between oral SCC and minor SGC. Full article

Background/Objectives: Cardiac sarcoidosis (CS) is a challenging diagnosis due to its subclinical progression and the limitations of existing screening tools. Cardiac magnetic resonance (CMR) and PET/CT imaging have improved diagnosis and detection. Aldosterone, a hormone with known profibrotic effects, may offer additional diagnostic value. We therefore aimed to determine whether plasma aldosterone level is associated with myocardial fibrosis, independent of active inflammation, in CS. Methods: This observational study included 541 patients with biopsy-proven sarcoidosis and preserved left ventricular ejection fraction (LVEF ≥ 50%). All underwent CMR with extracellular volume (ECV) mapping and 18F-FDG PET/CT to assess myocardial fibrosis and inflammation, respectively. Plasma aldosterone levels were also measured. Results: Plasma aldosterone levels were significantly higher in patients with cardiac sarcoidosis (172 [IQR 106–235] pg/mL) compared to those without cardiac involvement (143 [100–205] pg/mL, p = 0.02). Aldosterone was independently associated with the presence of late gadolinium enhancement (LGE) on CMR (OR 1.002 per 1 pg/mL increase; 95% CI 1.001–1.004, p = 0.04) and with higher ECV values (β = 0.008 per 1 pg/mL, p = 0.001). Regression analysis showed that aldosterone is associated with ECV (b-0.009, CI: 0.002–0.016, p = 0.009) and there was no interaction according to LGE status indicating a relationship with diffuse myocardial fibrosis even in the absence of visible scarring. No association was observed with T1-, T2-, or PET/CT-defined inflammation. Conclusions: Plasma aldosterone is a robust marker of myocardial fibrosis in sarcoidosis, particularly in early or subclinical stages. Its correlation with ECV—but not with inflammatory imaging markers—suggests its link with myocardial diffuse fibrotic remodeling before, and independently of, overt scarring or inflammation. Full article

Fibrinolysis is a natural component of hemostasis in which a no-longer-needed clot is gradually dissolved to restore blood flow. Under pathological thrombotic conditions, this process can be pharmacologically enhanced to promote clot removal. However, thrombolytic therapy has limited efficacy and is associated with a risk of bleeding complications, including intracranial hemorrhage. Fibrinolysis targets only the fibrin-rich part of the thrombus, whereas a substantial fraction of the clot is enriched with non-fibrin components such as extracellular DNA, von Willebrand factor, and extracellular matrix proteins, including collagen, fibronectin, and laminin. These structural regions, which may constitute half or more of the clot volume, remain resistant to classical fibrinolytic agents. To overcome these limitations, recent therapeutic strategies aim to degrade these non-fibrin elements to improve thrombolytic efficacy and reduce adverse effects. In this review, we summarize current trends in pharmacological clot dissolution, discuss novel agents in clinical use and development, and outline how targeting non-fibrin components may influence the future of thrombolytic therapy. Full article

Cardiac computed tomography (CT) has long evolved as a highly accurate screening tool for coronary artery disease. New technologies such as multi-detector rows and artifact reduction by a new motion correction algorithm have made it possible to evaluate coronary artery stenosis with higher diagnostic accuracy and lower radiation exposure. In addition to the anatomical evaluation of coronary arteries, the introduction of fluid dynamic analysis enables the measurement of coronary fractional flow reserve (FFR) for each stenotic lesion, which can only be achieved through invasive catheter evaluation. Myocardial ischemia can now also be detected using myocardial stress perfusion CT imaging. In addition, with the advent of dual-energy imaging or new image reconstruction technology, the addition of late contrast phase imaging enables myocardial late enhancement and left ventricular (LV) extracellular volume (ECV) analysis, which was previously possible only with cardiac magnetic resonance imaging (MRI). It has also been reported that LV ECV may be useful in predicting prognosis in cases with cardiomyopathies. In addition, retrospective imaging of the entire heart in a single cardiac cycle is now possible with lower radiation exposure, enabling not only morphological evaluation of the heart and valves but also myocardial strain analysis, which has conventionally been evaluated mainly by echocardiography and is expected to be applied in clinical practice in the future. Cardiac CT, which overcomes the weaknesses of other modalities while demonstrating greater usefulness through the latest technological development, is expected to expand its field of application to the entire heart analysis. The purpose of this review is to provide an overview of the technological development of cardiac CT, which has seen remarkable development in recent years, along with its clinical utility, with the aim of enabling clinicians to fully utilize it in daily practice. Full article

Background: Differentiating between immune checkpoint inhibitor (ICI) myocarditis and non-ICI myocarditis is clinically important. Cardiovascular magnetic resonance (CMR) is a well-established method for diagnosing acute myocarditis. The value of CMR for distinguishing ICI myocarditis from non-ICI myocarditis remains unclear, which this study sought to determine. Methods: A total of 54 patients (n = 26 ICI myocarditis; n = 28 non-ICI myocarditis) underwent clinical CMR for the assessment of cardiac function (cines), myocardial fibrosis (native T1-mapping, extracellular volume [ECV] fraction, late gadolinium enhancement [LGE]) and myocardial oedema (native T2-mapping). Results: ICI myocarditis patients were older than non-ICI myocarditis patients (75 years [71–78] vs. 39 years [30–64]; p < 0.001). Both groups had similar left ventricular (LV) ejection fraction (58 ± 11% vs. 58 ± 6%; p = 0.970). ICI myocarditis and non-ICI myocarditis patients also had similar native myocardial T1 values (1041 ± 84 ms vs. 1063 ± 60 ms; p = 0.281), native myocardial T2 values (59 ± 6 ms vs. 59 ± 6 ms; p = 0.943) and ECV (0.32 ± 0.07 vs. 0.31 ± 0.04; p = 0.403). Native myocardial T1 values (Rho = −0.553) and ECV (Rho = −0.502) were significantly associated with LVEF in non-ICI myocarditis patients (both p < 0.05). There was no significant association between myocardial T1 values, T2 values or ECV, with LVEF, in ICI myocarditis patients (all p < 0.05). Non-ICI myocarditis patients had a greater frequency of LGE in the LV compared to ICI myocarditis patients (89% vs. 52% p = 0.005). However, the pattern of LGE was similar between the two patient groups (mostly subepicardial and/or mid-wall). Conclusions: In this single centre retrospective cohort, the findings suggest that quantitative parametric mapping methods by CMR may not differentiate between ICI vs. non-ICI myocarditis. Further work is needed to assess the value of CMR for diagnosing standalone ICI myocarditis. Full article

Objectives: This exploratory preclinical study aimed to compare the correlations of apparent diffusion coefficient (ADC) and native T1 mapping histogram features with tumor cell proliferation, microvessel density (MVD), and extracellular matrix composition in neuroblastoma xenografts. Methods: Neuroblastoma xenografts (n = 42) were established by subcutaneously injecting three MYCN-amplified/non-amplified human neuroblastoma cell lines (IMR-32, SK-N-BE(2), and SH-SY5Y; n = 14 per group) into female immunodeficient BALB/c-nude mice. Once tumors reached a diameter within the range of 12–15 mm, native T1 mapping and diffusion-weighted imaging were performed using a 3.0T clinical MRI scanner. Tumor cell proliferation and MVD were assessed via immunohistochemical Ki-67 staining and CD31 staining, respectively. Collagen fibers were visualized using Masson staining to calculate the collagen volume fraction (CVF). Pearson correlation coefficients with false discovery rate (FDR) correction were used to evaluate their associations. Results: Significant negative correlations were observed between Ki-67 expression and multiple ADC values after FDR correction, including ADC_10Percentile (r = −0.397, adjusted p = 0.032), ADC_90Percentile (r = −0.394, adjusted p = 0.032), ADC_maximum (r = −0.362, adjusted p = 0.048), ADC_mean (r = −0.421, adjusted p = 0.032), ADC_median (r = −0.422, adjusted p = 0.032), ADC_minimum (r = −0.390, adjusted p = 0.032), and ADC_{rootmeansquared} (r = −0.419, adjusted p = 0.032). In contrast, multiple T1 mapping features showed significant positive correlations with CVF (adjusted p < 0.05). Conclusions: ADC and T1 mapping provide complementary insights into tumor proliferation and extracellular matrix composition in neuroblastoma. These preclinical findings support further research to validate their potential clinical utility. Full article

Objective: This study aimed to evaluate the hepatic volume, iodine concentration, and extracellular volume (ECV) of each hepatic segment in cirrhotic patients using three-dimensional (3D) volumetric iodine mapping of the liver segment derived from contrast-enhanced dual-energy CT (DECT) superimposed on extracted color-coded CT liver segments in comparison with non-cirrhotic patients. Methods: The study population consisted of 66 patients, 34 with cirrhosis and 32 without cirrhosis. Using 3D volumetric iodine mapping of the liver segment derived from contrast-enhanced DECT superimposed on extracted color-coded CT liver segments, the volume and iodine concentration of each hepatic segment in the portal venous phase (PVP) and equilibrium phase (EP), the difference in iodine concentration between PVP and EP (ICPVP-liver—ICEP-liver), and ECV fractions were compared between cirrhotic and non-cirrhotic groups. Results: The iodine concentration was not significantly different in all hepatic segments between the cirrhotic and non-cirrhotic groups. Conversely, the difference in iodine concentration between PVP and EP (ICPVP-liver—ICEP-liver) was significantly smaller in the cirrhosis group than in the non-cirrhosis group for all hepatic segments (p < 0.001). The ECV fraction of the left medial segment was significantly higher in the cirrhosis group than in the non-cirrhotic group ([26.4 ± 7.6] vs. [23.1 ± 5.1]; p < 0.05). Conclusions: The decreased difference in iodine concentration between PVP and EP calculated from 3D volumetric iodine mapping of the liver segment using DECT may be a clinically useful indicator for evaluating patients with compensated cirrhosis, suggesting a combined effect of a reduced portal venous flow and increased interstitial space associated with fibrosis. Full article

Background/Objectives: With the aging of the population, the number of patients with osteoporosis is increasing worldwide. Osteoporosis results from an imbalance in bone remodeling by osteoblasts and osteoclasts. This study investigated the effects of sake lees and rice koji, traditional Japanese rice-fermented products, on bone metabolism. Methods: Both sake lees extract and rice koji extract increased alkaline phosphatase (ALP) activity, extracellular collagen accumulation, and mineralization of MC3T3-E1 cells. In addition, the intracellular protein levels of Hsp47 and Sec23IP, which are required for collagen maturation and secretion, respectively, were increased during the differentiation. On the other hand, both extracts significantly inhibited osteoclastic differentiation. Furthermore, the effects of freeze-dried sake lees or rice koji extract on osteoporotic bones were examined using twelve-week-old female C3H/HeJ ovariectomized (OVX) mice. Results: The groups of mice fed 20% or 40% freeze-dried sake lees showed significant suppression of the loss in bone volume fraction (BV/TV) and trabecular volume (Tb.V) compared with those fed a normal diet as well as the 40% freeze-dried sake lees-fed group reduced in the loss of trabecular thickness (Tb.Th). Similarly, the rice koji extract-treated mice showed significant inhibition of the loss in BV/TV, Tb.V, and even trabecular number (Tb.N.). Folic acid and S-adenosylmethionine (SAM), which have been reported to be present in sake lees, promoted extracellular collagen production by osteoblasts. Conclusions: In OVX mice, the intake of freeze-dried sake lees or rice koji extract was associated with the attenuation of trabecular bone loss, suggesting potential beneficial effects on bone metabolism. Full article

The understanding of medulloblastoma (MB) progression is limited by the lack of minimally invasive monitoring methods. Extracellular vesicles (EVs) carrying disease-specific signatures are promising for liquid biopsies, but clinical translation is hindered by inconsistent isolation techniques. This study compares small EVs (sEVs) and their proteomes from blood plasma (BP) and cerebrospinal fluid (CSF) in MB. Using ultrafiltration and size exclusion chromatography (UF-SEC), we isolated sEVs from pediatric patient samples. sEV proteins from matched CSF-BP samples from MB patients (MBCSF/MBBP), healthy BP controls (HCBP), and MB cell lines (MBCL) were analyzed by liquid chromatography-tandem mass spectrometry, subjected to Gene Ontology and Cytoscape analyses, and compared to published MB, CSF, and EV datasets. By optimizing UF-SEC for small volumes, we found that CSF-sEVs are smaller and elute in later SEC fractions. Proteins linked to the extracellular matrix (ECM) were enriched in MBCSF and MBCL, while integrin binding showed inconsistent patterns between MBCSF and MBBP. MBBP and HCBP showed no significant differences. Fourteen proteins from MB datasets were identified in our analysis and primarily enriched in CSF. These findings support CSF-sEVs as more informative than BP-sEVs for MB diagnosis and monitoring, emphasize the need for fluid-specific sEV isolation, and suggest that ECM components and integrins may mediate MB progression. Full article

Extracellular volume fraction (ECV) analysis on computed tomography (CT) is now available. The purpose of this study was to assess the usefulness of CT-derived ECV analysis for predicting outcomes in patients with hypertrophic cardiomyopathy (HCM). One hundred and one HCM patients (67 males, 66 ± 11 years old) who received cardiac CT between January 2009 and December 2021 were included. We measured left ventricular (LV) ECV (LV-ECV) on CT and investigated the relationship between LV-ECV and the major adverse cardiac events (MACE) after CT. Fifteen patients (15%) experienced MACE. The patients with MACE had a significantly higher LV-ECV, left atrial diameter, LV end-systolic diameter, and lower LVEF than those without MACE. The proportion of dilated phase HCM was significantly higher in the patients with MACE than those without MACE. LV-ECV and LVEF were significant predictors of MACE based on the multivariate analysis by Cox proportional hazards model. The optimal threshold of LV-ECV to predict MACE was 37.6% based on the receiver operating characteristic analysis. The patients with LV-ECV ≥ 37.6% (30 patients) experienced significantly higher MACE than those with LV-ECV < 37.6% (p < 0.001). CT-derived ECV analysis suggested potential usefulness for predicting MACE in patients with HCM. Full article

Background: Crohn’s disease (CD) is a chronic disorder characterized by transmural bowel wall involvement and mesenteric changes, including inflammation and fibrosis. Although Magnetic Resonance Imaging (MRI)-based scoring systems have been proposed for the quantitative assessment of bowel wall changes in Magnetic Resonance enterography (MRE), there has been limited discussion regarding methods for the quantitative evaluation of mesenteric involvement. T1 mapping is an emerging MRI technique, potentially reflecting inflammation and fibrosis. This study aimed to assess the clinical utility of mesenteric T1 mapping in patients with CD. Methods: We retrospectively analyzed 71 adults with CD who underwent MRE from October 2024 to May 2025. Mesenteric native T1, post-contrast T1 relaxation times, their difference (ΔT1), and the extracellular volume (ECV) fraction were measured. Regions of interest were placed in mesenteric tissue adjacent to affected bowel segments, avoiding lymph nodes and artifacts. The Crohn’s Disease Activity Index (CDAI) was used to classify disease activity. Group differences and correlations with CDAI were evaluated. Results: Native T1 values were significantly higher in active CD than inactive disease (414.3 ms vs. 355.2 ms, p < 0.001). ΔT1 was also elevated in active disease (122.5 ms vs. 55.9 ms, p < 0.001), while post-contrast T1 and ECV did not differ significantly. Native T1 and ΔT1 showed significant positive correlations with CDAI (r = 0.53 and r = 0.46, respectively), while ECV had a weaker correlation (r = 0.27, p = 0.025). Conclusions: Mesenteric T1 mapping shows potential as a non-invasive biomarker of mesenteric involvement in CD. With further validation, mesenteric T1 mapping could enable more comprehensive disease assessment and improve the accuracy of clinical characterization in patients with Crohn’s disease. Full article

Astrocyte-derived extracellular vesicles (ADEVs) have emerged as promising neuroprotective agents for ischemic stroke. In this study, we evaluated the therapeutic potential of hypoxia-conditioned ADEVs (HxEVs) administered intracerebroventricularly in a rat model of transient middle cerebral artery occlusion (tMCAO). Serial magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) was performed at 1, 7, 14, and 21 days post-stroke. HxEV treatment produced a significant reduction in infarct volume from day 1, sustained through day 21, and was accompanied by improvements in motor and sensory recovery. DTI analyses showed progressive normalization of fractional anisotropy (FA) and radial diffusivity (RD), particularly in the corpus callosum and striatum, reflecting microstructural repair. In contrast, mean diffusivity (MD) was less sensitive to these treatment effects. Regional differences in therapeutic response were evident, with earlier and more sustained recovery in the corpus callosum than in other brain regions. Histological findings confirmed greater preservation of dendrites and axons in HxEV-treated animals, supporting the role of these vesicles in accelerating post-stroke neurorepair. Together, these results demonstrate that hypoxia-conditioned ADEVs promote both structural and functional recovery after ischemic stroke. They also highlight the value of DTI-derived biomarkers as non-invasive tools to monitor neurorepair. The identification of region-specific therapeutic effects and the validation of reliable imaging markers provide a strong foundation for future research and development. Full article

Background/Objectives: Survivors of sepsis can develop left ventricular (LV) systolic function with focal myocardial fibrosis. The relationship between diffuse myocardial fibrosis or oedema and LV systolic function remains unknown in this patient cohort. This study sought to address this knowledge gap using cardiovascular magnetic resonance (CMR) parametric mapping methods. Methods: Sepsis survivors who underwent CMR at a UK cardiac centre were included. CMR images analysed include cines, native T1-mapping, native T2-mapping, and post-contrast T1-mapping. Synthetic extracellular volume (ECV) fraction was also estimated. Native myocardial T1 values, native myocardial T2 values, and ECV values were compared against LV ejection fraction (LVEF). Results: Of the 37 sepsis survivors (age 53 ± 16 years old; 57% males), the mean left ventricular ejection fraction (LVEF) was 55% (IQR 43–62), and 43% of the patients had LV systolic dysfunction (LVEF < 50%). Mean native myocardial T1 values were 1055 ± 65 ms (septal) and 1051 ± 60 ms (global). Mean synthetic ECV values were 0.30 ± 0.04. Mean native myocardial T2 values were 52 ± 7 ms (septal) and 53 ± 6 ms (global). Septal and global native myocardial T1 values were not significantly correlated with LVEF (rho = 0.080, p = 0.637; rho = 0.036, p = 0.831, respectively). Synthetic ECV was not significantly correlated to LVEF (rho = −0.082; p = 0.723). Septal and global native myocardial T2 values were weakly correlated with LVEF (rho = 0.261, p = 0.281; rho = 0.216, p = 0.375, respectively). On ROC analysis, the performance of native myocardial T1 values, ECV, and native myocardial T2 values for predicting LV dysfunction was modest (AUC: 0.53 ± 0.10, 0.54 ± 11, and 0.68 ± 0.14; all p > 0.05, respectively). Conclusions: CMR markers of diffuse myocardial fibrosis (native T1-mapping and ECV) and myocardial oedema (native T2-mapping) have weak relationships with left ventricular systolic function in this study cohort of sepsis survivors. Further work is needed to better assess the role of diffuse myocardial fibrosis and oedema in the pathophysiology of post-sepsis cardiomyopathy. Full article

Background and Objectives: The extracellular volume fraction (fECV) of the liver, as measured by contrast-enhanced computed tomography (CT), has been shown to correlate closely with the histological stages of hepatic fibrosis. This study aimed to investigate the diagnostic performance of a liver extracellular volume fraction derived from dual-energy CT (DECT) for evaluating liver functional reserve based on the Child–Pugh class in cirrhotic patients, compared with other noninvasive markers. Materials and Methods: This retrospective study included 258 patients with liver cirrhosis who underwent contrast-enhanced DECT. The fECV was measured using iodine maps derived from equilibrium phase images obtained 3 min after contrast injection at 100/140 Sn kVp. Statistical analyses included Welch’s ANOVA with post hoc tests, Spearman’s correlation, and ROC analysis. The area under the curve (AUC) was compared among fECV and other noninvasive markers (aspartate transaminase to platelet ratio index [APRI], Fibrosis-4 [FIB-4], and model for end-stage liver disease [MELD]) using DeLong’s test. Intra- and interobserver reliability of fECV was assessed with the intraclass correlation coefficient (ICC). The area under the receiver operating characteristic curve (AUC) for differentiating Child–Pugh classes was compared among the fECV and other noninvasive markers (aspartate transaminase to platelet ratio index [APRI], Fibrosis-4 [FIB-4], and model for end-stage liver disease [MELD]). Results: The fECV increased significantly with advancing Child–Pugh classes (p < 0.001), showing a moderate correlation with Child–Pugh class (r = 0.53). The mean differences in fECV among the Child–Pugh classes were 8.88 between A and B (95% confidence interval [CI], 5.85–11.92; p < 0.001) and 7.42 between B and C (95% CI, 1.92–12.91: p < 0.001). The AUC for differentiating Child–Pugh classes A and B demonstrated no significant differences among the fECV (0.84), APRI (0.83, p > 0.99) and FIB-4 (0.83, p > 0.99), except for MELD, which had a significantly higher AUC (0.94, p = 0.047). For differentiating Child-Pugh classes B and C, the fECV demonstrated a significantly higher AUC (0.78), compared with FIB-4 (0.50, p = 0.038) and APRI (0.49, p = 0.037), whereas no significant difference was observed between fECV and MELD (0.92, p = 0.12). The intra- and interobserver reliabilities of the fECV measurements were excellent (ICC, 0.93; 95% CI, 0.91–0.95 and 0.91; 95% CI, 0.88–0.92, respectively). Conclusions: DECT derived fECV is a useful noninvasive marker for assessing liver functional reserve based on the Child–Pugh classification. Full article