PURPOSE: This study aimed to analyze the predictive value of caudate to right lobe ratio (CRL-R) and liver segmental volume ratio (LSVR) for chronic liver disease (CLD) on routine abdominal CT scans and their association with 5-year decompensation- and transplant-free survival. METHOD: This retrospective study included 108 patients without CLD and 98 patients with biopsy-proven CLD. All patients underwent abdominal CT scans between 03/2015 and 08/2017. Patients with CLD were divided into three groups: early CLD (F0-F2
eCLD
n = 40), advanced CLD (F3-F4
aCLD
n = 20), and aCLD with clinically significant portal hypertension (aCLDPH
n = 38). CRL-R and LSVR were compared between groups using Kruskal-Wallis test and ROC analysis to determine cutoff-values. 5-year decompensation- and transplant-free survival were assessed by Kaplan-Meier curve analysis. RESULTS: CRL-R and LSVR were significantly different between all groups (p <
0.001). A CRL-R cutoff-value of >
0.99 predicted aCLD with a sensitivity of 69% and a specificity of 80% (AUC = 0.75, p <
0.001), while LSVR >
0.37 had a sensitivity of 67% and a specificity of 84% (AUC = 0.80, p <
0.001). CLD-patients with both CRL-R >
0.99 and LSVR >
0.37 had a significantly lower probability of 5-year decompensation-free survival (31%) as well as lower probability of 5-year transplant-free survival (41%) than those with a CRL-R <
0.99 and/or LSVR <
0.37 (70%, 62%, p = 0.006, p = 0.038). CONCLUSION: CRL-R and LSVR showed a high predictive value for CLD on routine abdominal CT scans. In patients with CLD, both CRL-R and LSVR may be combined and are associated with 5-year decompensation-free and transplant-free survival.