Abstract: Objective: To evaluate the value of dual-energy spectral CT in assessing the hemodynamics in children with cholestatic cirrhosis before liver transplant. Methods: 60 children with cholestatic cirrhosis were selected retrospectively. There were 28 Child-Pugh grades A, 20 Child-Pugh grade B, and 12 Child-Pugh grade C cases based on the Child-Pugh classification criteria of liver function. Enhanced CT scan was performed using the gemstone spectral imaging (GSI) mode. The iodine concentrations for the hepatic parenchyma in the arterial phase (I_A) and portal vein phase (I_P) were measured using the iodine-based MD images with Region of interest (ROI) setting in the same location and size. The hepatic artery iodine fraction (AIF) was calculated as:AIF=iodine content (arterial phase)/iodine content (portal venous phase). The I_A, I_P and AIF of children of different Child-Pugh grades with cholestatic cirrhosis were analyzed by one-way ANOVA. Result: The I_A, I_P (100 μg/cm³) and AIF of different Child-Pugh Grades were as follows:Child-Pugh A:(4.34±2.0) 100 μg/cm³, (12.68±2.8) 100 μg/cm³ and 0.34±0.12; Child-Pugh B:(5.65±2.8) 100 μg/cm³, (14.49±3.8) 100 μg/cm³ and 0.38±0.13; Child-Pugh C:(7.09±2.6) 100 μg/cm³, (13.89±3.5) 100 μg/cm³ and 0.51±0.14. The one-way ANOVA showed that the overall difference of I_A and AIF between different Child-Pugh groups was statistically significant (P<0.05), and there was no statistically significant difference in I_P among different Child-Pugh groups (P>0.05). The multiple comparisons results indicated that I_A between grade A and grade C was significantly different. (P=0.004). AIF values were significantly different between Grade A and grade C (P=0.001), grade B and grade C (P=0.015), among which the AIF value of grade C is higher than that of grade B, and the AIF of grade A is the lowest. Conclusion: the AIF obtained by the dual energy spectral CT can be used as an indicator to evaluate the liver hemodynamics of children with cholestatic cirrhosis quantitatively.