AI-based Hepatic Steatosis Detection and Integrated Hepatic Assessment from Cardiac CT Attenuation Scans Enhances All-cause Mortality Risk Stratification: A Multi-center Study

作者：J. Yi, K. Patel, Robert J. H. Miller, A. Marcinkiewicz, A. Shanbhag, W. Hijazi, Naga L Dharmavaram, M. Lemley, Jian-Hang Zhou, Wenhao Zhang, Joanna X. Liang, G. Ramirez, V. Builoff, L. Slipczuk, M. Travin, E. Alexanderson, I. Carvajal-Juarez, R. R. Packard, M. Al-Mallah, T. D. Ruddy, A. J. Einstein, A. Feher, E. Miller, W. Acampa, S. Knight, V. Le, S. Mason, V. Calsavara, P. Chareonthaitawee, S. Wopperer, Alan C. Kwan, Lixia Wang, Daniel S. Berman, D. Dey, M. D. Di Carli, P. Slomka · 发表于：medRxiv · 年份：2025 · DOI：10.1101/2025.06.09.25329157 · 被引用次数：4 · 研究领域：Medicine

Background: Hepatic steatosis (HS) is a common cardiometabolic risk factor frequently present but under-diagnosed in patients with suspected or known coronary artery disease. We used artificial intelligence (AI) to automatically quantify hepatic tissue measures for identifying HS from CT attenuation correction (CTAC) scans during myocardial perfusion imaging (MPI) and evaluate their added prognostic value for all-cause mortality prediction. Methods: This study included 27039 consecutive patients [57% male] with MPI scans from nine sites. We used an AI model to segment liver and spleen on low dose CTAC scans and quantify the liver measures, and the difference of liver minus spleen (LmS) measures. HS was defined as mean liver attenuation < 40 Hounsfield units (HU) or LmS attenuation < -10 HU. Additionally, we used seven sites to develop an AI liver risk index (LIRI) for comprehensive hepatic assessment by integrating the hepatic measures and two external sites to validate its improved prognostic value and generalizability for all-cause mortality prediction over HS. Findings: Median (interquartile range [IQR]) age was 67 [58, 75] years and body mass index (BMI) was 29.5 [25.5, 34.7] kg/m2, with diabetes in 8950 (33%) patients. The algorithm identified HS in 6579 (24%) patients. During median [IQR] follow-up of 3.58 [1.86, 5.15] years, 4836 (18%) patients died. HS was associated with increased mortality risk overall (adjusted hazard ratio (HR): 1.14 [1.05, 1.24], p=0.0016) and in...