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Validation of functional liver imaging scores (FLIS) derived from gadoxetic acid–enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Child-Pugh score and FLIS

  • Hepatobiliary-Pancreas
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An Editorial Comment to this article was published on 23 August 2021

Abstract

Objectives

To validate the functional liver imaging score (FLIS) for prediction of hepatic function in gadoxetic acid–enhanced MRI.

Methods

We retrospectively identified 134 patients (88 men, 46 women; mean age, 58.8 years) between January 2015 and December 2018 with the following inclusion criteria: patients diagnosed with liver cirrhosis or chronic liver disease (CLD) who underwent gadoxetic acid–enhanced MRI. Three parameters on hepatobiliary phase images were evaluated for FLIS: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified as CLD (n = 11), Child-Pugh (CP) class A (n = 87), CP B (n = 22), or CP C (n = 14). We assessed the correlation between CP score and both FLIS and its components using Spearman rank correlation. Receiver operating characteristic (ROC) curve analysis was performed to demonstrate the cutoff value of FLIS for differentiating between CP classes. The associations between patient characteristics, serum markers, FLIS, and hepatic decompensation were evaluated with Cox proportional hazard models.

Results

FLIS and three FLIS parameters showed strong to very strong correlation with CP score (r = −0.60 to 0.82). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of CP class A or CLD (sensitivity, 83.7%; specificity, 94.4%; area under the curve [AUC], 0.93). FLIS < 5 was independently associated with the development of first hepatic decompensation in patients with CP A (HR, 50.0; 95% confidence interval, 6.2, 400.4).

Conclusion

FLIS showed a strong correlation with hepatic function and can stratify the CP class. In addition, FLIS can help prediction for the development of first decompensation.

Key Points

• Functional liver imaging scores (FLIS) and its three parameters, derived from hepatobiliary phase image, have strong to very strong correlations with Child-Pugh (CP) scores.

• FLIS can stratify patients with chronic liver disease or liver cirrhosis according to CP classification.

• Low FLIS is an independent predictor for first hepatic decompensation in patients with CP class A.

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Abbreviations

ALBI:

Albumin-bilirubin

CLD:

Chronic liver disease

CP:

Child-Pugh

FIB-4:

Fibrosis-4

FLIS:

Functional liver imaging score

LC:

Liver cirrhosis

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea

    Ho Jun Lee, Seung Baek Hong, Nam Kyung Lee & Suk Kim

  2. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea

    Hyung Il Seo

  3. Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea

    Dong Uk Kim & Sung Yong Han

  4. Department of Radiology, Biomedical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea

    Ki Suk Choo

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  1. Ho Jun Lee
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Correspondence to Seung Baek Hong.

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Lee, H.J., Hong, S.B., Lee, N.K. et al. Validation of functional liver imaging scores (FLIS) derived from gadoxetic acid–enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Child-Pugh score and FLIS. Eur Radiol 31, 8606–8614 (2021). https://doi.org/10.1007/s00330-021-07955-1

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  • DOI: https://doi.org/10.1007/s00330-021-07955-1

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