Evaluation of liver function in patients with cirrhosis based on dual-energy CT imaging combined with serum fibrosis markers：a feasibility study

Evaluation of liver function in patients with cirrhosis based on dual-energy CT imaging combined with serum fibrosis markers：a feasibility study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of liver function in patients with cirrhosis based on dual-energy CT imaging combined with serum fibrosis markers：a feasibility study Zhenhua Wang, Zhijun Dai, Yongqi Zhu, Xiaomeng Shi, Shuai Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7141662/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objectives To investigate the value of imaging markers based on dual-energy CT combined with serum fibrosis markers in the evaluation of liver cirrhosis and liver function. Methods We prospectively enrolled patients with cirrhosis and normal liver function. Three different methods were used to calculate fECV, and the ratio of right liver volume to total liver volume (RV/TLV) and left liver volume to total liver volume (LV/TLV) were calculated. The aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (Fib-4) index were measured. The liver function was assessed according to the Child-Pugh grade. ROC curve was used to analyze the diagnostic efficacy of each indicators for liver cirrhosis. Multivariate logistic regression was used to screen independent risk factors for cirrhosis, and a cirrhosis prediction model was constructed. AUC analysis model prediction efficiency, calibration curve and Hosmer-Lemeshow test to evaluate the model fit. Results Among the included indicators, fECV − iodine had the highest diagnostic efficacy for cirrhosis [ AUC = (0.818,0.731 ~ 0.887)]. The fECV − iodine [ OR = (1.264,1.130 ~ 1.415), P < 0.001]and Fib-4 [ OR = (4.309,1.449 ~ 12.811), P = 0.009] were independent risk factors for cirrhosis, predictive model based on the above two indicators for the diagnosis of liver cirrhosis further improved [ AUC = (0.845,0.761 ~ 0.908), the calibration curve showed that the model fit well. Additionally, the prediction model effectively predicted Child-Pugh grade B and above [ AUC = (0.833,0.720 ~ 0.947)] as well as Child-Pugh grade C [ AUC = (0.888,0.794 ~ 0.984)], showcasing excellent prediction efficiency. Conclusion fECV may be regarded as a reliable imaging indexes, and further play a role in the evaluation of cirrhosis and liver function grading in combining with serological markers. Cirrhosis dual-energy CT Liver function Child-Pugh grade Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 15 Oct, 2025 Reviewers invited by journal 26 Sep, 2025 Editor invited by journal 03 Sep, 2025 Editor assigned by journal 21 Jul, 2025 Submission checks completed at journal 18 Jul, 2025 First submitted to journal 18 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7141662","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525754225,"identity":"a3753e58-7a28-46db-8005-e629e64a8329","order_by":0,"name":"Zhenhua Wang","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhenhua","middleName":"","lastName":"Wang","suffix":""},{"id":525754226,"identity":"12b91866-76a3-4b1e-973c-47ce7b848d13","order_by":1,"name":"Zhijun Dai","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhijun","middleName":"","lastName":"Dai","suffix":""},{"id":525754227,"identity":"e02eea57-9ce5-4092-85f4-5dad11be6d4c","order_by":2,"name":"Yongqi Zhu","email":"","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yongqi","middleName":"","lastName":"Zhu","suffix":""},{"id":525754228,"identity":"12fe52f0-77e8-4c7b-b772-ce3e7789c83e","order_by":3,"name":"Xiaomeng Shi","email":"","orcid":"","institution":"GE Healthcare China","correspondingAuthor":false,"prefix":"","firstName":"Xiaomeng","middleName":"","lastName":"Shi","suffix":""},{"id":525754229,"identity":"170bb436-185b-44a4-a62e-9ab351b794c3","order_by":4,"name":"Shuai Zhang","email":"","orcid":"","institution":"GE Healthcare China","correspondingAuthor":false,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Zhang","suffix":""},{"id":525754230,"identity":"87ee8844-bf82-4621-a89b-e279577cb18f","order_by":5,"name":"Dazhi Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYDACCQYDBsYGCTkGZlK1GJOshSGxgWgd/LObN378ucMifX4778EPDDU20YQtuXOsWELyjETuhsN8yRIMx9JyCVpnIJFjIGHYBtTCzGMgwdhwmCgtxj8S2yTS5Zt5jH8Qq8VM4mCbRALDYR4z4myRuJFWZtnYJmG4AajFIoEYv/DPSN5882dbnbx8/xnjGx9qbAhrQQUJpCkfBaNgFIyCUYALAABw4jlTCXRwZgAAAABJRU5ErkJggg==","orcid":"","institution":"People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University","correspondingAuthor":true,"prefix":"","firstName":"Dazhi","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-07-16 15:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7141662/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7141662/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93058864,"identity":"f3e0bcf9-0843-437c-a7e3-8a8ede7d4a31","added_by":"auto","created_at":"2025-10-08 15:24:11","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":528338,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/7110d5d5209f4cace70e4f25.docx"},{"id":93058827,"identity":"b8b56bad-0be6-449e-8ec2-46d523640b6a","added_by":"auto","created_at":"2025-10-08 15:24:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19086,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/9131fec918cafa220ee17729.docx"},{"id":93058919,"identity":"6d04c54b-44d3-48e4-a954-9df65ffa212e","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1273546,"visible":true,"origin":"","legend":"","description":"","filename":"Fig10.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/427e5f3aa4944895a3bdd339.jpg"},{"id":93059251,"identity":"fbd02544-794c-406a-bd1d-ceab2f549ee2","added_by":"auto","created_at":"2025-10-08 15:32:10","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1729938,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1a.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1f162eb2135301e957ed0f45.jpg"},{"id":93058892,"identity":"7b56e903-aa4f-4f60-9414-4d7391d10db2","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1544439,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1b.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/716788962680ace639a245b3.jpg"},{"id":93058830,"identity":"02af72d4-0865-4854-8b81-a1a6324d0716","added_by":"auto","created_at":"2025-10-08 15:24:09","extension":"jpg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1644942,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1c.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/e6618e17e865168b3c10ff4c.jpg"},{"id":93059275,"identity":"0af87339-aa3b-495b-889f-a179c1a5a688","added_by":"auto","created_at":"2025-10-08 15:32:13","extension":"jpg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1531886,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1d.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/18396a714ce50da882cbc8ad.jpg"},{"id":93059282,"identity":"d8aff7f3-cbc9-44c4-9d1c-abaef0e45e7c","added_by":"auto","created_at":"2025-10-08 15:32:14","extension":"jpg","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116264,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2a.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/599525dc1dcf58a19768a11d.jpg"},{"id":93058843,"identity":"4ca47d13-f521-492e-9650-4166fa35c7fb","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"jpg","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":576931,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2b.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/88a7fa0afb0a3001b0a7c52e.jpg"},{"id":93060155,"identity":"4b33ae50-b70c-4a33-82d9-8e995e4f0c63","added_by":"auto","created_at":"2025-10-08 15:40:13","extension":"jpg","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":270709,"visible":true,"origin":"","legend":"","description":"","filename":"Fig3.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f6734b9182b6c3293c73f0e0.jpg"},{"id":93058852,"identity":"14d1c741-51e9-4499-b303-84fd3331eeb6","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"jpg","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":655493,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4a.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/05f0628d4bdbae8cb16e5257.jpg"},{"id":93058947,"identity":"b53f44f3-016d-40d8-9c9c-b79605850bc0","added_by":"auto","created_at":"2025-10-08 15:24:15","extension":"jpg","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":654595,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4b.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/4f8decc1f6dfd86d2c20e489.jpg"},{"id":93058895,"identity":"9ae25eb6-dee1-4e11-a833-973536e6f4df","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":541629,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4c.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/fe43615cbfb6c697093daeb7.jpg"},{"id":93058929,"identity":"1dd0ff8a-b8f0-41bc-9386-4ecb4d6a1612","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"jpg","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":612546,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4d.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/3b7475ca40e8f6c28e70af27.jpg"},{"id":93059253,"identity":"437b175b-a68d-4847-bb68-9ff1aec9285d","added_by":"auto","created_at":"2025-10-08 15:32:10","extension":"jpg","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":405479,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4e.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/bbf1832a765e5b8357b6784b.jpg"},{"id":93060152,"identity":"1ae7c794-ea62-4218-af64-6b4a1ee416eb","added_by":"auto","created_at":"2025-10-08 15:40:11","extension":"jpg","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":678441,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4f.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/3c0f42a870540b55cb8f6a4c.jpg"},{"id":93058835,"identity":"f2d91f74-5af5-47e4-9b2f-a3e7544370b1","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"tif","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51370,"visible":true,"origin":"","legend":"","description":"","filename":"Fig5.jpg.tif","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/010493984951c1fa33c6ba81.tif"},{"id":93058860,"identity":"90035594-b69d-4583-be21-b0646edf3a0b","added_by":"auto","created_at":"2025-10-08 15:24:11","extension":"tif","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68532,"visible":true,"origin":"","legend":"","description":"","filename":"Fig6.jpg.tif","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/fad14e9f894b4da4537c7e50.tif"},{"id":93058838,"identity":"a283a356-4f94-4313-9ea7-ce81cc9970d3","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"tif","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35248,"visible":true,"origin":"","legend":"","description":"","filename":"Fig7.jpg.tif","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/57cfd1e16468fb93d1427b6a.tif"},{"id":93058889,"identity":"7760c930-62fc-406b-aec5-eb31a459f924","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1104928,"visible":true,"origin":"","legend":"","description":"","filename":"Fig8.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f937d89aaace12a782fc6305.jpg"},{"id":93058937,"identity":"2000c0e9-d667-4780-955f-53e8a13d1fe9","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"jpg","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1255439,"visible":true,"origin":"","legend":"","description":"","filename":"Fig9.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/8a278e6d7d5f3a186a3e0b17.jpg"},{"id":93058911,"identity":"6cab74e5-51ee-4596-992f-fdb80e162aea","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"json","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7655,"visible":true,"origin":"","legend":"","description":"","filename":"3fe8d5b8c5e74b489dc7b45ee7fdeb14.json","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/e877aa00699d97da5fb76c0d.json"},{"id":93058833,"identity":"fc1e7d90-9c77-4d27-aca3-74fa1903b92e","added_by":"auto","created_at":"2025-10-08 15:24:09","extension":"xml","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":165640,"visible":true,"origin":"","legend":"","description":"","filename":"3fe8d5b8c5e74b489dc7b45ee7fdeb141enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/8f861690ceb9189102075c43.xml"},{"id":93058897,"identity":"c08d285a-c6c2-4a6b-ac46-475a20de409e","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1273546,"visible":true,"origin":"","legend":"","description":"","filename":"Fig10.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/37bfd9579a03ccd4fe996b10.jpg"},{"id":93058893,"identity":"d8d978e5-79e2-4f9a-98dd-412e87e3019b","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1729938,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1a.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/32fa7ee08b1a1f565fe473f7.jpg"},{"id":93058829,"identity":"c2069dff-9a95-4ed7-8b84-6791212372b1","added_by":"auto","created_at":"2025-10-08 15:24:09","extension":"jpg","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1544439,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1b.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/fc27392b711f77fc146c31e5.jpg"},{"id":93060156,"identity":"73c104cf-bb30-46bf-a170-3799cf886844","added_by":"auto","created_at":"2025-10-08 15:40:14","extension":"jpg","order_by":26,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1644942,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1c.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/c216ffbf33ecefdde8682a85.jpg"},{"id":93058905,"identity":"706bc75e-666d-4376-ac4f-d6669ef11b10","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"jpg","order_by":27,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1531886,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1d.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/4569082235d09d6d1aae5710.jpg"},{"id":93059260,"identity":"4d082c7b-525e-473a-a73d-98ef481cf204","added_by":"auto","created_at":"2025-10-08 15:32:11","extension":"jpg","order_by":28,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116264,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2a.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/60464a3ff87d04a64fb0ec68.jpg"},{"id":93058933,"identity":"2ed121d4-1d80-4a6f-b922-e3581ba97c5e","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"jpg","order_by":29,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":576931,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2b.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/460e454a23e82e95bf86bbb5.jpg"},{"id":93058888,"identity":"1da8d7e6-d587-4b04-a696-959d73ef49a7","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":30,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":270709,"visible":true,"origin":"","legend":"","description":"","filename":"Fig3.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1ac2904462d06f4568f3a65b.jpg"},{"id":93058887,"identity":"057c8723-542b-43fe-80d3-d7e79e32d1b3","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpg","order_by":31,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":655493,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4a.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/dce76166b6342ceb50d5aac4.jpg"},{"id":93058915,"identity":"e1dfbe73-f1fd-4406-b544-37b1fa37a336","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"jpg","order_by":32,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":654595,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4b.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/cf4e365a6c4875dd6230b393.jpg"},{"id":93058913,"identity":"b93aa35c-2404-43c2-8a3a-d9e6b60b5827","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"jpg","order_by":33,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":541629,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4c.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/c4cca7bc857ac143c3ee2688.jpg"},{"id":93059284,"identity":"28b3bab0-f3b1-4131-93df-f10fb2b991cc","added_by":"auto","created_at":"2025-10-08 15:32:14","extension":"jpg","order_by":34,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":612546,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4d.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/713adf09e79d8b0cc5c45fc2.jpg"},{"id":93058865,"identity":"27990fd7-0dd6-49a1-8c82-e9b25d416a5b","added_by":"auto","created_at":"2025-10-08 15:24:11","extension":"jpg","order_by":35,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":405479,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4e.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1c54ef3b8b7a501ee495b2b6.jpg"},{"id":93060158,"identity":"cc0d8ac1-cb38-4e34-8adb-fc6bac8effdc","added_by":"auto","created_at":"2025-10-08 15:40:14","extension":"jpg","order_by":36,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":678441,"visible":true,"origin":"","legend":"","description":"","filename":"Fig4f.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/97fe8f0322a54005715d95e4.jpg"},{"id":93060151,"identity":"a60d82bb-ed96-41ae-8c5a-ae69c32fffb4","added_by":"auto","created_at":"2025-10-08 15:40:10","extension":"tif","order_by":37,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51370,"visible":true,"origin":"","legend":"","description":"","filename":"Fig5.jpg.tif","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1e58668d57cce2c15aeff857.tif"},{"id":93058841,"identity":"32f2972c-987b-4e32-a4e3-2b498d3d2db2","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"tif","order_by":38,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68532,"visible":true,"origin":"","legend":"","description":"","filename":"Fig6.jpg.tif","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/3c9d1320a44fcf745a94f627.tif"},{"id":93058928,"identity":"e366bd20-f7b1-4fe4-83c2-6be3697e5f69","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"tif","order_by":39,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35248,"visible":true,"origin":"","legend":"","description":"","filename":"Fig7.jpg.tif","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/6f3b65490861f47d08f02623.tif"},{"id":93059254,"identity":"5ed0201a-3049-42cb-b6d8-b6a5a90fd64c","added_by":"auto","created_at":"2025-10-08 15:32:10","extension":"jpg","order_by":40,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1104928,"visible":true,"origin":"","legend":"","description":"","filename":"Fig8.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f70f0b10a0450d08758fdb24.jpg"},{"id":93058921,"identity":"3c6fc771-cedc-478b-b919-63195ea6c571","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"jpg","order_by":41,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1255439,"visible":true,"origin":"","legend":"","description":"","filename":"Fig9.jpg.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f41a36d53ec4f1a88f976d07.jpg"},{"id":93058898,"identity":"abf92811-096a-4654-8379-323d80794725","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"eps","order_by":42,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":803,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage1.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f7a699314f3192bc6e7fce8d.eps"},{"id":93058901,"identity":"421a9457-196c-4f7a-a442-390b602189c8","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"eps","order_by":43,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49469,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage10.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/4a9f1914f6292951ce21d10c.eps"},{"id":93058855,"identity":"791adf8b-6f60-46ea-b5d0-0764cbd5cb4b","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"eps","order_by":44,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49699,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage11.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/7b39e544df4e7646fb6bd4b9.eps"},{"id":93059289,"identity":"2095bac3-95a1-44ca-a1e5-dee6daa3ff4e","added_by":"auto","created_at":"2025-10-08 15:32:16","extension":"eps","order_by":45,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50283,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage12.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1b2ece5fc869d65b4b45ea39.eps"},{"id":93058847,"identity":"f9101c76-5842-4976-b476-1fe11696a0e7","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"eps","order_by":46,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49567,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage13.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/dd6337951a1b53232bb28a3a.eps"},{"id":93058946,"identity":"6ffed7e1-fa9d-4656-9ab3-0155a6f56e7b","added_by":"auto","created_at":"2025-10-08 15:24:15","extension":"eps","order_by":47,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50224,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage2.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/430a07c4b3aaf887c3774bfa.eps"},{"id":93058840,"identity":"1a6068a5-6ab0-4b4a-8ec0-4258d22526fa","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"eps","order_by":48,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49262,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage3.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1667b8db310ac3588b99c169.eps"},{"id":93058858,"identity":"8c1ba3a9-9091-4ebd-a402-7162c400e0e8","added_by":"auto","created_at":"2025-10-08 15:24:11","extension":"eps","order_by":49,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49336,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage4.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/a79867e6fb7ba691b5b0258c.eps"},{"id":93058909,"identity":"e811e9dd-7c39-4c31-b73e-e7761ae4079a","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"eps","order_by":50,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49566,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage5.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/b7e18b87f4d612826f41709f.eps"},{"id":93059266,"identity":"67b7c387-3376-4781-9cc9-929784cebe37","added_by":"auto","created_at":"2025-10-08 15:32:12","extension":"eps","order_by":51,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50756,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage6.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/6210705c6816cb002c7b1ed0.eps"},{"id":93059270,"identity":"fda929cf-d845-492e-ab57-d0fa3dcb16ed","added_by":"auto","created_at":"2025-10-08 15:32:12","extension":"eps","order_by":52,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49794,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage7.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/237bc33cfded9807b96ae863.eps"},{"id":93058826,"identity":"89ba1c95-0492-46ee-b36f-8c056b447b8c","added_by":"auto","created_at":"2025-10-08 15:24:08","extension":"eps","order_by":53,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50357,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage8.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/44e76f798bed45a850462ed7.eps"},{"id":93060159,"identity":"ee6e3548-cb88-4553-a0b6-1c707bafa81e","added_by":"auto","created_at":"2025-10-08 15:40:16","extension":"eps","order_by":54,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49395,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage9.eps","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/6b79424aa2629d0242cb62aa.eps"},{"id":93058940,"identity":"3a58c2b6-8552-4afe-b5df-d8e659a5829a","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"jpeg","order_by":55,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":160171,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/c824669981e504e06c6358f8.jpeg"},{"id":93059261,"identity":"aa57d505-00e9-4c1a-a720-be236ec089ce","added_by":"auto","created_at":"2025-10-08 15:32:11","extension":"jpeg","order_by":56,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11789,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage10.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/b02a5d9e0d5c8c1b8914512a.jpeg"},{"id":93058942,"identity":"f39be00d-6144-4130-bde1-5de387fe3ac9","added_by":"auto","created_at":"2025-10-08 15:24:15","extension":"jpeg","order_by":57,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9882,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage11.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/13e7b43342deacaaebf0d1ee.jpeg"},{"id":93059280,"identity":"da4cea57-105e-4b83-b761-17c0636bc45c","added_by":"auto","created_at":"2025-10-08 15:32:13","extension":"jpeg","order_by":58,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10146,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage12.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f58ca3d6f14cd6fb8b3c3367.jpeg"},{"id":93059286,"identity":"3a30c718-c7e7-492e-bd2c-e1605fd5bb34","added_by":"auto","created_at":"2025-10-08 15:32:14","extension":"jpeg","order_by":59,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7425,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage13.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/b4f0f377389ad88753417975.jpeg"},{"id":93060150,"identity":"f3f45b2f-6188-4a86-9155-57a1b1b5c193","added_by":"auto","created_at":"2025-10-08 15:40:10","extension":"jpeg","order_by":60,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14452,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage14.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/852d2d263b8a9f628993ad43.jpeg"},{"id":93058944,"identity":"a63781c2-5579-4963-93c0-a071e08697d3","added_by":"auto","created_at":"2025-10-08 15:24:15","extension":"jpeg","order_by":61,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51370,"visible":true,"origin":"","legend":"","description":"","filename":"Fig5.jpg.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/50fbd2c2ad318564623e329f.jpeg"},{"id":93058925,"identity":"e0076c63-e4a1-48a9-92de-1895fd8f14fb","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"jpeg","order_by":62,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68532,"visible":true,"origin":"","legend":"","description":"","filename":"Fig6.jpg.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/e344935c887c967889919447.jpeg"},{"id":93058834,"identity":"707d9873-a674-441a-a56d-98f5514d3374","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"jpeg","order_by":63,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":213406,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage17.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/01860997635fbc68d3a326c5.jpeg"},{"id":93058842,"identity":"aa95dee5-c4d9-4c48-80d3-cbc5d29a9409","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"jpeg","order_by":64,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":163732,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage18.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/1435092bfbd392b5ac2552c5.jpeg"},{"id":93058845,"identity":"9e5cb5e3-edfd-4f6f-97c2-3f1d95343baa","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"jpeg","order_by":65,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24567,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/e578b3c8a562cb8489c256b2.jpeg"},{"id":93058935,"identity":"573aaa7f-87f3-4d88-a7cc-e20f728ae482","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"jpeg","order_by":66,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22930,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/b3cc86a43142253779bd921c.jpeg"},{"id":93059281,"identity":"f7b8da7c-48ae-4caf-86ac-d38db20a6302","added_by":"auto","created_at":"2025-10-08 15:32:14","extension":"jpeg","order_by":67,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19816,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/0e1a1642798fb342cbf76cff.jpeg"},{"id":93059265,"identity":"cd4384a4-6c7e-4e42-8a72-d4d2fc47e2f7","added_by":"auto","created_at":"2025-10-08 15:32:12","extension":"jpeg","order_by":68,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14756,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/a14c403195fd1c7b6b4899a8.jpeg"},{"id":93059252,"identity":"0283d1f0-ec95-4a9d-9aeb-0152cbf52e9a","added_by":"auto","created_at":"2025-10-08 15:32:10","extension":"jpeg","order_by":69,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5496,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/df456c0e3ea4cb476727647c.jpeg"},{"id":93058950,"identity":"3d69b3ca-6601-4aa0-a3f5-755c3e67880d","added_by":"auto","created_at":"2025-10-08 15:24:16","extension":"jpeg","order_by":70,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19600,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/7b06990ded9dcefa1c84e22a.jpeg"},{"id":93058899,"identity":"81b73191-8827-41ff-83a0-63d7ea473c28","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpeg","order_by":71,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49132,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/be53d14370b8ab0efe1c38fc.jpeg"},{"id":93058886,"identity":"dfc05ec5-6939-4bf2-9df0-fb858c482f20","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"jpeg","order_by":72,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11460,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/349711fa45bef85798720a66.jpeg"},{"id":93059288,"identity":"37591ab5-4753-4c07-ba29-628b57bdb517","added_by":"auto","created_at":"2025-10-08 15:32:15","extension":"png","order_by":73,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124500,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig10.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/319202117dbdcffe81c27923.png"},{"id":93058930,"identity":"a50680cb-0b42-41cd-b352-1082cea71c21","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"png","order_by":74,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":881305,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1a.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/4d87181a09a0b85d3d8f8bb9.png"},{"id":93060153,"identity":"54f94e77-35ef-4da4-a697-dd5fa619d7e5","added_by":"auto","created_at":"2025-10-08 15:40:12","extension":"png","order_by":75,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2883449,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1b.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/58a561769ae7524be0434928.png"},{"id":93059291,"identity":"6231ca8d-bc9d-433b-bdfe-1f77e773f403","added_by":"auto","created_at":"2025-10-08 15:32:16","extension":"png","order_by":76,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":806826,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1c.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/7715d5c2312efb6684be0183.png"},{"id":93058863,"identity":"7014c09f-470b-48b2-b1f4-98ee1913b74d","added_by":"auto","created_at":"2025-10-08 15:24:11","extension":"png","order_by":77,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2347246,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1d.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/2754817c694cfa98bf4642ce.png"},{"id":93058916,"identity":"7f87bd90-2d94-40d0-927d-046a36a22402","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"png","order_by":78,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34482,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig2a.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/624115bb6a73aa40a081d2c4.png"},{"id":93058850,"identity":"6ffdb855-feec-4c03-9a83-8c6963ef352c","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"png","order_by":79,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":217596,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig2b.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/115b400c83ddf85aff12764f.png"},{"id":93058906,"identity":"7ce7a358-16b8-4072-9086-3381dc45970e","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"png","order_by":80,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85637,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig3.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/33021731b264e72c2197bfa2.png"},{"id":93058831,"identity":"de2543da-6afc-41c1-b35b-399d57e72c4e","added_by":"auto","created_at":"2025-10-08 15:24:09","extension":"png","order_by":81,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1222164,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4a.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/2b2bf67fa2bcc7329a48e94c.png"},{"id":93058924,"identity":"ca121828-148b-4973-866e-5a1015c77f01","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"png","order_by":82,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1269094,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4b.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/d1d5b944f03b0ecbeeabbbdb.png"},{"id":93059272,"identity":"964d5688-43a4-45ad-aa02-f7a263592cfb","added_by":"auto","created_at":"2025-10-08 15:32:13","extension":"png","order_by":83,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":978666,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4c.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/6b18240a876db7bf0c92a0d2.png"},{"id":93058952,"identity":"ddbce3d8-3ffa-4d10-b698-4e991efe0ccb","added_by":"auto","created_at":"2025-10-08 15:24:16","extension":"png","order_by":84,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":139551,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4d.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/a9423e13028b405d2f39de28.png"},{"id":93058849,"identity":"9ddf0d22-127f-4986-a8b0-4e7274827de5","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"png","order_by":85,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94082,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4e.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/0b56c67fd9a3a2cbd0e89f1c.png"},{"id":93058890,"identity":"fba32c41-dd0a-47b4-a546-f04762548d0f","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"png","order_by":86,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":213619,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4f.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/4c5ec7251255dc6ebace898b.png"},{"id":93059278,"identity":"371c818d-1ca1-454b-aeb8-c889915666dc","added_by":"auto","created_at":"2025-10-08 15:32:13","extension":"png","order_by":87,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21703,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig5.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/b82e13a56c3a9ef842d1e763.png"},{"id":93058931,"identity":"f303362a-5474-4e78-ac4a-4c3f21679a5d","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"png","order_by":88,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24718,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig6.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/c8e50d4f5ac253a9674b5441.png"},{"id":93059249,"identity":"8aa1c475-3704-48a1-b6ca-2c2a8ef12345","added_by":"auto","created_at":"2025-10-08 15:32:09","extension":"png","order_by":89,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16068,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig7.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f5bf7246c02a5554ae6208ce.png"},{"id":93059269,"identity":"f3d67ad9-fb1b-44b8-b49c-549d0e8e0ef5","added_by":"auto","created_at":"2025-10-08 15:32:12","extension":"png","order_by":90,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106125,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig8.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/96aed8f5cf72d551dff51b5f.png"},{"id":93058948,"identity":"4102226b-f908-4f37-9380-2a08238421b3","added_by":"auto","created_at":"2025-10-08 15:24:16","extension":"png","order_by":91,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":169604,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig9.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/d3a4a7d718a881c38eb1e0f4.png"},{"id":93058918,"identity":"dd722655-4abb-4b3b-a34c-e441bf3d44c8","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"png","order_by":92,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30344,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/443d979ca6db6fc399aad552.png"},{"id":93060154,"identity":"95434666-8b8a-45d3-a4ed-8980afc0260d","added_by":"auto","created_at":"2025-10-08 15:40:12","extension":"png","order_by":93,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":36435,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/dd6f946bae56412ad7b6e2d6.png"},{"id":93059250,"identity":"0e2148e0-265f-407d-976d-bf88e74eb4a6","added_by":"auto","created_at":"2025-10-08 15:32:10","extension":"png","order_by":94,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32608,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/746a3535a2a855b722581dc9.png"},{"id":93058883,"identity":"0e5f16a8-783c-46c3-9b46-bf94475aa450","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"png","order_by":95,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11302,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage12.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/3e42234634a54b4909ebcf4a.png"},{"id":93058891,"identity":"495eca57-c1ed-406f-9e6f-dd668dd2f2ff","added_by":"auto","created_at":"2025-10-08 15:24:12","extension":"png","order_by":96,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8563,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage13.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/114c2a13a9dfccac8aa30df4.png"},{"id":93058926,"identity":"e5f73d53-0e89-46eb-bc04-594ab560ab11","added_by":"auto","created_at":"2025-10-08 15:24:14","extension":"png","order_by":97,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27982,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage14.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/30086ec0f8e8b29c1f7bf97b.png"},{"id":93059268,"identity":"f62c4a4d-b800-46c8-b5a3-d3f0bd859894","added_by":"auto","created_at":"2025-10-08 15:32:12","extension":"png","order_by":98,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21703,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage15.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/0887257ca0bea11af667ac1d.png"},{"id":93059258,"identity":"4b1e5e66-4e11-4842-92e7-5ceb9366a735","added_by":"auto","created_at":"2025-10-08 15:32:11","extension":"png","order_by":99,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24718,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage16.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/9c903bb3ac9849262e739f83.png"},{"id":93059255,"identity":"af0c3296-a245-4654-b85c-c806659f3df8","added_by":"auto","created_at":"2025-10-08 15:32:10","extension":"png","order_by":100,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35588,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage17.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/78ba00dad1db2e60adb10856.png"},{"id":93059263,"identity":"a69f7639-9d13-4237-b8fc-c382b36c2775","added_by":"auto","created_at":"2025-10-08 15:32:11","extension":"png","order_by":101,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23383,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage18.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/9fdfbfd4ca9ed6aa8b411d0a.png"},{"id":93058836,"identity":"d96e05f2-f403-4ac4-aa44-301fc85b5990","added_by":"auto","created_at":"2025-10-08 15:24:10","extension":"png","order_by":102,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27534,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/5c6542e9090652639a4b06c6.png"},{"id":93059259,"identity":"94e3fade-c9e5-4a3b-8fb1-d596a2adbd44","added_by":"auto","created_at":"2025-10-08 15:32:11","extension":"png","order_by":103,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76585,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/99f1ac6abb3e31be99a1c412.png"},{"id":93058954,"identity":"65ef68f2-9eb1-491b-91c7-72b097ca4da8","added_by":"auto","created_at":"2025-10-08 15:24:16","extension":"png","order_by":104,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":26940,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/16b8a52fda9e3215cb48885a.png"},{"id":93058945,"identity":"c55f09ba-1ac7-4754-b94d-316547468a65","added_by":"auto","created_at":"2025-10-08 15:24:15","extension":"png","order_by":105,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69672,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/31cc31a91f0d43c9c0d607a1.png"},{"id":93058923,"identity":"a5d3226d-e4a2-42d8-9823-9bf8768610d6","added_by":"auto","created_at":"2025-10-08 15:24:13","extension":"png","order_by":106,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4909,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/2d2de063f3d3b608d11827fb.png"},{"id":93060157,"identity":"4975541d-9c53-4378-8f76-ef09676a97ae","added_by":"auto","created_at":"2025-10-08 15:40:14","extension":"png","order_by":107,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":21241,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/76577286d864396b537c56ea.png"},{"id":93059274,"identity":"e7c9229c-28be-4977-9be4-93f2c7aa3feb","added_by":"auto","created_at":"2025-10-08 15:32:13","extension":"png","order_by":108,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29164,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/f71c81b2bfeebd7ab66f5832.png"},{"id":93059262,"identity":"c6157c3e-50a2-4a5d-b508-0ecc5b0229c3","added_by":"auto","created_at":"2025-10-08 15:32:11","extension":"png","order_by":109,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35184,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/a3f9ae4db55634fd11f99c13.png"},{"id":93059279,"identity":"b4565f53-5917-40c4-9ce8-09ccf18a0a2a","added_by":"auto","created_at":"2025-10-08 15:32:13","extension":"xml","order_by":110,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":160517,"visible":true,"origin":"","legend":"","description":"","filename":"3fe8d5b8c5e74b489dc7b45ee7fdeb141structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/849bae24ca7466b364378eee.xml"},{"id":93058857,"identity":"5ef98c36-d759-4e94-b3ff-56b3fb0b0108","added_by":"auto","created_at":"2025-10-08 15:24:11","extension":"html","order_by":111,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":178345,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1/b45ce649dcd97e3ec5b82306.html"},{"id":93060161,"identity":"eb98f4f2-a8ca-4020-a9bc-ecdb8b7df556","added_by":"auto","created_at":"2025-10-08 15:40:22","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":807850,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7141662/v1_covered_1bab2483-e946-4d30-904d-ccbdb3250c86.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of liver function in patients with cirrhosis based on dual-energy CT imaging combined with serum fibrosis markers：a feasibility study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cirrhosis, dual-energy CT, Liver function, Child-Pugh grade","lastPublishedDoi":"10.21203/rs.3.rs-7141662/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7141662/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo investigate the value of imaging markers based on dual-energy CT combined with serum fibrosis markers in the evaluation of liver cirrhosis and liver function.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe prospectively enrolled patients with cirrhosis and normal liver function. Three different methods were used to calculate fECV, and the ratio of right liver volume to total liver volume (RV/TLV) and left liver volume to total liver volume (LV/TLV) were calculated. The aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (Fib-4) index were measured. The liver function was assessed according to the Child-Pugh grade. ROC curve was used to analyze the diagnostic efficacy of each indicators for liver cirrhosis. Multivariate logistic regression was used to screen independent risk factors for cirrhosis, and a cirrhosis prediction model was constructed. AUC analysis model prediction efficiency, calibration curve and \u003cem\u003eHosmer-Lemeshow\u003c/em\u003e test to evaluate the model fit.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the included indicators, fECV\u003csub\u003e\u0026minus;\u0026thinsp;iodine\u003c/sub\u003e had the highest diagnostic efficacy for cirrhosis [ AUC = (0.818,0.731\u0026thinsp;~\u0026thinsp;0.887)]. The fECV\u003csub\u003e\u0026minus;\u0026thinsp;iodine\u003c/sub\u003e [ \u003cem\u003eOR\u003c/em\u003e= (1.264,1.130\u0026thinsp;~\u0026thinsp;1.415), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001]and Fib-4 [ \u003cem\u003eOR\u003c/em\u003e= (4.309,1.449\u0026thinsp;~\u0026thinsp;12.811), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009] were independent risk factors for cirrhosis, predictive model based on the above two indicators for the diagnosis of liver cirrhosis further improved [ AUC = (0.845,0.761\u0026thinsp;~\u0026thinsp;0.908), the calibration curve showed that the model fit well. Additionally, the prediction model effectively predicted Child-Pugh grade B and above [ AUC = (0.833,0.720\u0026thinsp;~\u0026thinsp;0.947)] as well as Child-Pugh grade C [ AUC = (0.888,0.794\u0026thinsp;~\u0026thinsp;0.984)], showcasing excellent prediction efficiency.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003efECV may be regarded as a reliable imaging indexes, and further play a role in the evaluation of cirrhosis and liver function grading in combining with serological markers.\u003c/p\u003e","manuscriptTitle":"Evaluation of liver function in patients with cirrhosis based on dual-energy CT imaging combined with serum fibrosis markers：a feasibility study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 15:23:33","doi":"10.21203/rs.3.rs-7141662/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"300480926918182768258982014066363520732","date":"2025-10-16T03:02:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-26T06:23:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-03T10:52:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-21T07:57:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-18T15:01:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-07-18T14:53:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ca672648-f440-47a1-a60c-563ea06dcaa7","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T15:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 15:23:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7141662","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7141662","identity":"rs-7141662","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}