From the Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, A-1090 Vienna, Austria (N.B., L.B., S.P.L., D.T., Y.B., M.C.E., H.E., M.W., J.C.H., A.B.); Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria (M.M., G.S., B.S., T.R.); Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria (M.M., G.S., B.S., T.R.); Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.); and Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, Calif (C.S.).
Radiology. 2020 Jan;294(1):98-107. doi: 10.1148/radiol.2019190734. Epub 2019 Nov 19.
Background Gadoxetic acid-enhanced MRI enables estimation of liver function in patients with chronic liver disease (CLD). The functional liver imaging score (FLIS), derived from gadoxetic acid-enhanced MRI, has been shown to predict transplant-free survival in liver transplant patients. Purpose To investigate the accuracy of the FLIS for predicting hepatic decompensation and transplant-free survival in patients with CLD. Materials and Methods Patients with CLD who had undergone gadoxetic acid-enhanced liver MRI, including T1-weighted volume-interpolated breath-hold examination sequences with fat suppression, performed between 2011 and 2015 were included. FLIS was assigned on the basis of the sum of three hepatobiliary phase features, each scored on an ordinal 0-2 scale: hepatic enhancement, biliary excretion, and the signal intensity in the portal vein. Patients were stratified into the following three groups according to fibrosis stage and a presence or history of hepatic decompensation: nonadvanced CLD, compensated advanced CLD (CACLD), and decompensated advanced CLD (DACLD). The predictive value of FLIS for first and/or further hepatic decompensation and for transplant-free survival was investigated by using Kaplan-Meier analysis, log-rank tests, and Cox regression analysis. Results This study evaluated 265 patients (53 years ± 14 [standard deviation]; 164 men). Intraobserver (κ = 0.98; 95% confidence interval: 0.97, 0.99) and interobserver (κ = 0.93; 95% confidence interval: 0.90, 0.95) agreement for FLIS were excellent. In patients with CACLD, the FLIS was independently predictive of a first hepatic decompensation (adjusted hazard ratio, 3.7; 95% confidence interval: 1.1, 12.6; = .04), but not for further hepatic decompensations in patients with DACLD (adjusted hazard ratio, 1.4; 95% confidence interval: 0.9, 1.9; = .17). The FLIS was an independent risk factor for mortality in both patients with CACLD (adjusted hazard ratio, 7.4; 95% confidence interval: 2.7, 20.2; < .001) and those with DACLD (adjusted hazard ratio, 3.8; 95% confidence interval: 1.7, 9.5; = .004). Conclusion The functional liver imaging score derived from gadoxetic acid-enhanced MRI identified patients with advanced chronic liver disease who are at increased risk for a first hepatic decompensation and for mortality. © RSNA, 2019
背景 钆塞酸增强 MRI 可用于估计慢性肝病（CLD）患者的肝功能。从钆塞酸增强 MRI 衍生的功能肝脏成像评分（FLIS）已被证明可预测肝移植患者的无移植生存率。
目的 探讨 FLIS 预测 CLD 患者肝失代偿和无移植生存率的准确性。
材料与方法 纳入 2011 年至 2015 年间接受钆塞酸增强肝脏 MRI 检查的 CLD 患者，包括 T1 加权容积内插屏气检查序列，带有脂肪抑制，行肝胆期扫描。FLIS 是根据三个肝胆期特征的总和计算的，每个特征均按序数值 0-2 评分：肝增强、胆汁排泄和门静脉信号强度。根据纤维化分期和肝失代偿的存在或病史，将患者分为以下三组：非进展性 CLD、代偿性晚期 CLD（CACLD）和失代偿性晚期 CLD（DACLD）。采用 Kaplan-Meier 分析、对数秩检验和 Cox 回归分析探讨 FLIS 对首次和/或进一步肝失代偿和无移植生存率的预测价值。
结果 本研究共评估了 265 例患者（53 岁±14 岁[标准差]；164 例男性）。FLIS 的观察者内（κ=0.98；95%置信区间：0.97，0.99）和观察者间（κ=0.93；95%置信区间：0.90，0.95）一致性均极佳。在 CACLD 患者中，FLIS 可独立预测首次肝失代偿（调整后的危险比，3.7；95%置信区间：1.1，12.6； =.04），但不能预测 DACLD 患者的进一步肝失代偿（调整后的危险比，1.4；95%置信区间：0.9，1.9； =.17）。FLIS 是 CACLD 患者（调整后的危险比，7.4；95%置信区间：2.7，20.2； <.001）和 DACLD 患者（调整后的危险比，3.8；95%置信区间：1.7，9.5； =.004）死亡的独立危险因素。
结论 从钆塞酸增强 MRI 衍生的功能肝脏成像评分可识别出患有晚期慢性肝病的患者，这些患者发生首次肝失代偿和死亡的风险增加。
