{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:25:54Z","timestamp":1782977154881,"version":"3.54.5"},"reference-count":21,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Hepatic involvement in COVID-19 is frequently observed, yet conventional CT imaging may fail to detect subtle parenchymal alterations. This study aimed to evaluate whether CT-based radiomic texture analysis can identify liver injury associated with SARS-CoV-2 infection. Methods: We retrospectively analyzed 41 patients with RT-PCR\u2013confirmed moderate or severe COVID-19 pneumonia who underwent non-contrast thoracoabdominal CT during the acute phase and at follow-up. Liver volume, mean hepatic attenuation, liver-to-spleen attenuation ratio, and radiomic features including first-order and GLCM entropy were extracted using 3D Slicer version 5.6.2 and SlicerRadiomic Revision: 8426cdf. Hepatic injury was defined by elevated serum transaminases. Three additional patients with available liver histopathology were included for correlation with imaging findings. Results: Patients with biochemical liver injury demonstrated significantly higher hepatic entropy values in the acute phase compared to those without injury (first-order entropy: 1.63 vs. 1.48, p = 0.019; GLCM entropy: 3.12 vs. 2.83, p = 0.013). Entropy metrics were inversely correlated with hepatic attenuation at follow-up (GLCM r = \u22120.385, p = 0.013; first-order r = \u22120.346, p = 0.027), indicating possible progression to lower-density states. Ferritin showed a moderate positive correlation with entropy (r = 0.47, p = 0.0017). Histopathological examination revealed steatosis, hepatocellular injury, inflammatory infiltration, and vascular congestion, aligning with radiomic abnormalities. Conclusions: Entropy-based CT radiomics reflect microstructural liver alterations in COVID-19, supported by both biochemical and histopathological data. This approach may enhance the detection of hepatic injury beyond conventional imaging and could be explored in systemic infections.<\/jats:p>","DOI":"10.3390\/diagnostics15182364","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T14:10:19Z","timestamp":1758118219000},"page":"2364","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Entropy-Based CT Radiomics as an Imaging Marker of Hepatic Injury in COVID-19"],"prefix":"10.3390","volume":"15","author":[{"given":"Alin Iulian","family":"Feiereisz","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, Str. Lucian Blaga, Nr. 2A, 550169 Sibiu, Romania"},{"name":"Infectious Diseases Clinic, Academic Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2965-3713","authenticated-orcid":false,"given":"George-C\u0103lin","family":"Oprinca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, Str. Lucian Blaga, Nr. 2A, 550169 Sibiu, Romania"},{"name":"Department of Pathology, Academic Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7391-3394","authenticated-orcid":false,"given":"Victoria","family":"Birlutiu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, Str. Lucian Blaga, Nr. 2A, 550169 Sibiu, Romania"},{"name":"Infectious Diseases Clinic, Academic Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"441","DOI":"10.4254\/wjh.v15.i4.441","article-title":"COVID-19 and liver injury: Pathophysiology, risk factors, outcome and management in special populations","volume":"15","author":"Roshanshad","year":"2023","journal-title":"World J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.3748\/wjg.v30.i22.2866","article-title":"Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications","volume":"30","year":"2024","journal-title":"World J. 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