Ho Jun Lee1, Seung Baek Hong2, Nam Kyung Lee1, Suk Kim1, Hyung Il Seo3, Dong Uk Kim4, Sung Yong Han4, Ki Suk Choo5. 1. Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea. 2. Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea. cinematiclife7@hanmail.net. 3. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea. 4. Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea. 5. Department of Radiology, Biomedical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
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.
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.
Entities:
Keywords:
Functional liver imaging scores; Gadoxetic acid; Liver cirrhosis; Liver function estimation; Magnetic resonance imaging