Comparative study of Gd-EOB-DTPA-enhanced magnetic resonance imaging signal intensity parameters and albumin-bilirubin grade for liver function assessment based on early and middle-stage of liver dysfunction.

BACKGROUND: Gadolinium-ethoxy benzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) enables not only liver lesion detection but also a one-stop assessment of hepatic function. Among the commonly used liver function scoring systems, the albumin-bilirubin (ALBI) grade is more objective than the Child-Turcotte-Pugh (CTP) grade and is particularly suitable for evaluating liver function in patients with early and middle-stage chronic liver disease. However, although various Gd-EOB-DTPA-enhanced MRI signal intensity (SI) parameters have been employed for liver function assessment, a comprehensive comparison of their efficacy is lacking, and no consensus exists on the optimal parameter. This study aimed to compare the efficacy of eight Gd-EOB-DTPA-enhanced MRI SI parameters in assessing liver function based on the ALBI grading system and identify the optimal imaging biomarker for clinical application.

METHODS: A total of 99 high-risk patients with hepatitis B-related hepatocellular carcinoma (HCC) in the early or middle stages (61 with ALBI grade 1 and 38 with ALBI grades 2-3) underwent Gd-EOB-DTPA-enhanced MRI. Eight parameters were analyzed, including the relative enhancement rate of hepatic parenchyma, liver-muscle contrast ratio, liver-spleen contrast ratio, liver-portal vein contrast ratio, liver-muscle ratio growth rate, liver-spleen ratio growth rate, relative SI of biliary tract, and portal vein-spleen contrast ratio. Statistical analyses included receiver operating characteristic (ROC) curves evaluation, Spearman correlation, and independent-samples t-test to compare diagnostic performance and correlate parameters with ALBI scores.

RESULTS: Liver-portal vein contrast ratio showed the numerically highest discriminative power for distinguishing ALBI grade 1 from grades 2-3 in all MRI parameters [area under the curve (AUC): 0.806, 95% confidence interval (CI): 0.715-0.897; sensitivity: 85.2%, specificity: 63.2%, cutoff value: 1.4763], followed by liver-spleen contrast ratio (AUC: 0.799, cutoff value: 1.7536) and relative enhancement rate of hepatic parenchyma (AUC: 0.765, cutoff value: 0.7874). Liver-muscle ratio growth rate exhibited moderate efficacy (AUC: 0.730, cutoff value: 0.9116). Parameters showed significant correlations with ALBI scores (|r|: 0.368-0.532, P<0.001), except for portal vein-spleen contrast ratio (r=0.116, P=0.253). The AUC of relative SI of biliary tract was 0.678. The cutoff value of relative SI of biliary tract was 4.3656. The assessment of portal vein-spleen contrast ratio did not show a significant association with functional differences (P=0.589).

CONCLUSIONS: Liver-portal vein contrast ratio showed the numerically best performance among all MRI parameters for differentiating ALBI grades in this study population, offering superior sensitivity for early-stage liver dysfunction assessment. Gd-EOB-DTPA-enhanced MRI not only enables a more accurate prediction of postoperative functional liver reserve but also provides a comprehensive foundation for clinicians to formulate optimal, individualized treatment strategies, thereby potentially reducing the incidence of postoperative complications. Meanwhile, we caution against reliance on portal vein-spleen contrast ratio or biliary signal measurements.