FULMINANT HEPATIC-FAILURE - OBSERVATION WITH SERIAL CT

PURPOSE: To determine the imaging characteristics of fulminant hepatic failure at serial computed tomography (CT) and to assess if any CT fi ndings have prognostic value. MATERIALS AND METHODS: In 40 patients, 2 07 CT scans were analyzed retrospectively. Thirty-four patients had fu lminant hepatic failure (acute in seven and subacute in 27), and six h ad late-onset hepatic failure. Twenty-one patients died of hepatic fai lure. CT was performed soon after the onset of coma and repeated weekl y. Liver volume was measured by tracing the hepatic contour and summin g the areas to estimate whole-liver volume. RESULTS: Liver volumes in survivors (n = 19) and nonsurvivors (n = 21), respectively, were 1,090 cm(3) +/- 300 and 830 cm(3) +/- 240 at initial CT and 1,130 cm(3) +/- 310 and 700 cm(3) +/- 280 at last CT (P = .0001). Ill-defined hypoatt enuating areas were noted in 20 patients and were distributed in a sol itary (n = 13), multiple (n = 6), or diffuse (n = 1) pattern. At follo w-up CT, the area of hypoattenuation increased in six patients (five n onsurvivors) and disappeared or markedly decreased in four survivors. An increase in or late occurrence of ascites was noted in 15 patients (14 nonsurvivors, P = .0001). CONCLUSION: Liver volumes at the initial and last CT examinations and an increase in or late occurrence of asc ites are useful prognostic findings.