Caudate lobe to right lobe ratio by two dimensional ultrasound in patients with liver cirrhosis and its relation to the severity of liver disease

Background and aim In liver cirrhosis (LC), the liver parenchyma undergoes diffuse alteration with the formation of regenerating nodules and remodeling. As the caudate lobe of the liver has a unique blood supply, it could be differently affected in LC. This study aimed to evaluate the relationship between the caudate to right lobe ratio (C/RL) and the severity of liver disease in patients with cirrhosis. Patients and methods We included 100 adult cases with distinct stages of LC. A thorough history, medical examinations, laboratory tests, imaging, and endoscopic evaluation were performed for all participants. Abdominal ultrasound, including measurement of the right lobe and caudate lobe dimensions and subsequent calculation of C/RL ratio were done for all patients. Results The mean Child–Pugh score was 7.89±1.67, while the mean model for end-stage liver disease score was 13.18±3.19. Among patients, 42% have been categorized as Child Class A, 52% as Class B, and 6% as Class C. The C/RL ratio positively correlated with both model for end-stage liver disease (r=0.77, P <0.001) and Child scores (r=0.68, P <0.001). Cases with Child class C had a significantly higher C/RL ratio compared with class A (0.70±0.19 vs. 0.49±0.12; P <0.001) and class B (0.70±0.19 vs. 0.63±0.19; P =0.03). C/RL ratio significantly predicted the presence of varices, with an area under the curve of 0.917 at a cutoff point greater than 0.55, with an overall accuracy of 93.8%. Conclusion The C/RL ratio serves as a simple, noninvasive tool for predicting and assessing the severity of liver disease. Further studies are recommended to validate these findings.