Multiparametric gadoxetic acid-enhanced magnetic resonance imaging (MRI) biomarkers demonstrate stage-dependent associations in chronic liver disease.

AIM: The aim of the study is to characterise the stage-dependent behaviour of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI) functional indices and volumetric biomarkers across clinically defined stages of chronic liver disease (CLD) using the EASL framework.

MATERIALS AND

METHODS

In this retrospective study, 140 adults with clinically or histopathologically confirmed CLD who underwent GA-MRI between March 2020 and June 2025 were categorised as nonadvanced CLD (NACLD; n = 18), compensated advanced CLD (CACLD; n = 97), or decompensated advanced CLD (DACLD; n = 25). Relative liver enhancement (RLE), contrast uptake index (CUI), liver-to-spleen index (LSI), and hepatocellular uptake index (HUI) were calculated from unenhanced and 20-minute hepatobiliary-phase images. Liver and spleen volumes were estimated using ellipsoid models. Group differences were assessed using Kruskal-Wallis and Dunn-Bonferroni tests. Receiver operating characteristic (ROC) analysis evaluated stage separation, and reproducibility was assessed using intraclass correlation coefficients (ICC).

RESULTS

Uptake-focused indices differed significantly across stages and correlated negatively with disease severity (HUI ρ = -0.250; LSI ρ = -0.228; both P ≤ 0.007). For separating NACLD from more advanced disease, spleen volume showed the highest descriptive performance (area under the curve [AUC] = 0.820; 95% confidence interval [CI]: 0.712-0.927), followed by HUI (AUC = 0.721; 95% CI: 0.592-0.851) and LSI (AUC = 0.709; 95% CI: 0.569-0.849). Enhancement-based parameters showed limited stage-associated differentiation, whereas RLE demonstrated modest performance for identifying DACLD (AUC = 0.662; 95% CI: 0.547-0.780). Inter-reader agreement was good-to-excellent for RLE, CUI, HUI, and volumetry (ICC = 0.854-0.961) and moderate for LSI (ICC = 0.714).

CONCLUSION

GA-MRI uptake indices and spleen volume show complementary stage-dependent associations across clinical CLD stages, supporting a multiparametric descriptive approach. External validation with haemodynamic reference standards is warranted.