Computed Tomography–Based Assessment of Hepatic Steatosis and Liver Fibrosis in a Congolese Population: A Radiological Method-Comparison Study.

Abstract

Background:

Hepatic steatosis and liver fibrosis are major contributors to chronic liver disease. In low-resource settings, computed tomography (CT) may serve as an accessible noninvasive tool for opportunistic hepatic assessment. However, CT-based evaluation of steatosis and fibrosis remains limited in sub-Saharan African populations. This study evaluated CT-derived parameters for hepatic steatosis and fibrosis in a Congolese population from Kinshasa and assessed agreement between hepatic attenuation and fibrosis-related morphology.

Methodology:

An analytical cross-sectional method-comparison study was conducted using 2,485 abdominal CT scans performed from January 2020 to June 2025 at Rocher Imaging Center, Kinshasa. Hepatic steatosis was assessed using mean hepatic attenuation and liver–spleen attenuation difference, while fibrosis was evaluated using morphological parameters, including caudate-right lobe ratio (CRL-R) and hepatic vein diameters. Agreement between mean hepatic attenuation and CRL-R was analyzed using Deming regression, Passing–Bablok regression, Bland–Altman analysis, Lin’s concordance correlation coefficient (CCC), RMSE, and P10 agreement.

Results:

The mean age of participants was 50.6 ± 14.2 years, and women represented 52.2% of the study population. Hepatic steatosis was identified in 14.0% of participants, while liver fibrosis was present in 9.0%. The prevalence of both conditions increased significantly with advancing age (p = 0.012). Deming regression analysis demonstrated a slope coefficient of 0.967 (95% CI: 0.919–1.016) and an intercept of −2.885 (95% CI: −7.135 to 3.360), indicating no significant proportional or systematic bias. Passing–Bablok regression similarly showed excellent linear agreement between the two radiological parameters. However, overall concordance remained moderate (Lin’s CCC = 0.423). Mean hepatic attenuation demonstrated a systematic underestimation of CRL-R values (bias = −5.392), although the P10 agreement metric remained high at 92.4%.

Conclusion:

CT-derived hepatic attenuation demonstrated a good linear relationship with the caudate-right lobe ratio, supporting the utility of CT-based radiological parameters in the noninvasive evaluation of hepatic abnormalities. However, moderate concordance and proportional bias suggest that these measurements should be considered complementary rather than fully interchangeable. CT may represent a practical opportunistic imaging tool for hepatic assessment in resource-limited settings where advanced fibrosis imaging techniques are not widely available.