Abstract
Background Autoimmune cholestatic liver diseases, such as the primary biliary cholangitis–autoimmune hepatitis overlap syndrome, represent a rare and diagnostically challenging group of chronic liver disorders. Liver biopsy remains the diagnostic gold standard; however, its invasiveness limits widespread use. Computed tomography perfusion imaging has emerged as a non-invasive method capable of assessing hepatic hemodynamics and detecting early fibrotic changes. To evaluate and compare computed tomography perfusion parameters—arterial flow, portal flow, and perfusion index—in patients with fibrosis and cirrhosis secondary to primary biliary cholangitis–autoimmune hepatitis overlap syndrome and in healthy controls. Materials and Methods This single-center prospective study included 30 patients with primary biliary cholangitis–autoimmune hepatitis overlap syndrome (18 with fibrosis and 12 with cirrhosis) and 20 healthy controls (potential living liver donors). Perfusion parameters were quantified using deconvolution-based analysis. Results A statistically significant increase in arterial flow values was observed in patients with fibrosis (p < 0.001) and cirrhosis (p < 0.001) compared with the control group. There was no statistically significant difference in portal flow or perfusion index values among the fibrosis and cirrhosis groups. Inter observer reproducibility for arterial and portal flow measurements was excellent, interclass correlation coefficient = 0.873 and 0.837, respectively. Conclusion Computed tomography perfusion imaging enables quantitative assessment of hepatic hemodynamics in patients with primary biliary cholangitis–autoimmune hepatitis overlap syndrome. Increased arterial flow may reflect hemodynamic alterations associated with fibrotic remodeling, even before cirrhosis develops.