JRM
Journal of Radiology in Medicine

Journal of Radiology in Medicine is an international journal that published original research and articles in all areas of radiology. Its publishes original research articles, review articles, case reports, editorial commentaries, letters to the editor, educational articles, and conference/meeting announcements.

eISSN: 3023-6487
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Original Article
Functional Liver Imaging Score on gadoxetic acid-enhanced MRI: correlation with MELD, ALBI, Child–Pugh, FIB-4, and diagnostic performance for advanced hepatic dysfunction in chronic liver disease
Abstract
Aims: The objective is to evaluate the diagnostic performance of the Functional Liver Imaging Score (FLIS) for the identification of severe hepatic dysfunction and the relationship between the FLIS on gadoxetic acid-enhanced MRI and established liver function scores in patients with chronic liver disease (CLD).
Methods: 104 patients with chronic liver disease who had gadoxetic acid-enhanced MRIs between January 2021 and December 2024 were the subjects of this retrospective study. Twenty-minute hepatobiliary phase images were used to score FLIS (0–6) based on portal vein signal intensity, biliary excretion, and parenchymal enhancement. The MELD, ALBI, Child-Pugh, and FIB-4 scores were computed using laboratory data obtained within two weeks before MRI.
Results: FLIS correlated with key biochemical markers of hepatic reserve (higher albumin and sodium; lower bilirubin and cholestatic/hepatocellular enzymes; all p<0.001) and showed strong correlations with MELD and ALBI (r=-0.63 each). Mean FLIS decreased from Child–Pugh A (5.66 ± 0.53) to B (3.85 ± 1.32) to C (1.57 ± 0.79) (p < 0.001). FLIS demonstrated high diagnostic accuracy for advanced dysfunction, with AUCs of 0.86 for MELD >15 and 0.94 for Child–Pugh B/C.
Conclusion: FLIS has high correlations with biochemical and composite scores of liver function and can well predict severe hepatic dysfunction. The moderate correlation of FLIS with FIB-4 indicates that FLIS is more a measure of functional reserve than fibrosis and thus confirms its utility as an imaging biomarker.

Keywords : Functional Liver Imaging Score, chronic liver disease, MELD, ALBI, Child-Pugh, FIB-4

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1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151-171. doi:10.1016/j.jhep.2018.09.014
2. Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023;79(2):516-537. doi:10.1016/j.jhep.2023.03.017
3. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217-231. doi:10.1016/j.jhep.2005.10.013
4. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550-558. doi: 10.1200/JCO.2014.57.9151
5. Toyoda H, Johnson PJ. The ALBI score: from liver function in patients with HCC to a general measure of liver function. JHEP Rep. 2022; 4(10):100557. doi:10.1016/j.jhepr.2022.100557
6. Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: the model for end-stage liver disease updated for the modern era. Gastroenterology. 2021;161(6):1887-1895.e4. doi:10.1053/j.gastro.2021.08.050
7. Río Bártulos C, Senk K, Schumacher M, et al. Assessment of liver function with MRI: where do we stand? Front Med (Lausanne). 2022;9: 839919. doi:10.3389/fmed.2022.839919
8. Baleato-González S, Vilanova JC, Luna A, et al. Current and advanced applications of gadoxetic acid-enhanced MRI in hepatobiliary disorders. Radiographics. 2023;43(4):e220087. doi:10.1148/rg.220087
9. Van Beers BE, Pastor CM, Hussain HK. Primovist, Eovist: what to expect? J Hepatol. 2012;57(2):421-429. doi:10.1016/j.jhep.2012.01.031
10. Tan CH, Chou SC, Inmutto N, et al. Gadoxetate-enhanced MRI as a diagnostic tool in the management of hepatocellular carcinoma: report from a 2020 Asia-Pacific multidisciplinary expert meeting. Korean J Radiol. 2022;23(7):697-719. doi:10.3348/kjr.2021.0593
11. Wang C, Yuan XD, Wu N, Sun WR, Tian Y. Optimization of hepatobiliary phase imaging in gadoxetic acid-enhanced magnetic resonance imaging: a narrative review. Quant Imaging Med Surg. 2023; 13(3):1972-1982. doi:10.21037/qims-22-916
12. Bastati N, Beer L, Ba-Ssalamah A, et al. Gadoxetic acid-enhanced MRI-derived functional liver imaging score (FLIS) and spleen diameter predict outcomes in ACLD. J Hepatol. 2022;77(4):1005-1013. doi: 10.1016/j.jhep.2022.04.032
13. Lee HJ, Hong SB, Lee NK, 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. 2021;31(11):8606-8614. doi:10. 1007/s00330-021-07955-1
14. Sakai N, Takayashiki T, Takano S, Suzuki D, Ohtsuka M. Low functional liver imaging score is associated with poor prognosis following hepatectomy for hepatocellular carcinoma. Sci Rep. 2024; 14(1):31290. doi:10.1038/s41598-024-82741-9
15. Maino C, Romano F, Franco PN, et al. Functional liver imaging score (FLIS) can predict adverse events in HCC patients. Eur J Radiol. 2024; 180:111695. doi:10.1016/j.ejrad.2024.111695
16. Aslan S, Eryuruk U, Tasdemir MN, Cakir IM. Determining the efficacy of functional liver imaging score (FLIS) obtained from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Albumin-Bilirubin (ALBI) grade and FLIS. Abdom Radiol (NY). 2022;47(7):2325-2334. doi:10.1007/s00261-022-03557-7
17. Yu QJ, Luo YC, Zuo ZW, et al. Utility of gadoxetate disodium-enhanced magnetic resonance imaging in evaluating liver failure risk after major hepatic resection. Quant Imaging Med Surg. 2024;14(5):3731-3743. doi: 10.21037/qims-23-1504
18. Ji YH, Son IW, Hong SB, et al. Functional Liver Imaging Score (FLIS) as imaging parameter for predicting post-hepatectomy complications in patients with liver cirrhosis. Acta Radiol. 2025;66(2):208-217. doi:10. 1177/02841851241299088
19. Tsoris A, Marlar CA. Use of the Child Pugh score in liver disease. In: StatPearls. Treasure Island (FL): StatPearls. 2019.
20. Johnson PJ, Pinato DJ, Kalyuzhnyy A, Toyoda H. Breaking the Child-Pugh dogma in hepatocellular carcinoma. J Clin Oncol. 2022;40(19): 2078-2082. doi:10.1200/JCO.21.02373
21. Toyoda H, Johnson PJ. The ALBI score: from liver function in patients with HCC to a general measure of liver function. JHEP Rep. 2022;4(10): 100557. doi:10.1016/j.jhepr.2022.100557
22. Cho WR, Hung CH, Chen CH, et al. Ability of the post-operative ALBI grade to predict the outcomes of hepatocellular carcinoma after curative surgery. Sci Rep. 2020;10(1):7290. doi:10.1038/s41598-020-64354-0
23. Pinato DJ, Sharma R, Allara E, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol. 2017;66(2):338-346. doi:10.1016/j.jhep.2016.09.008
24. Zhao S, Wang M, Yang Z, et al. Comparison between Child-Pugh score and Albumin-Bilirubin grade in the prognosis of patients with HCC after liver resection using time-dependent ROC. Ann Transl Med. 2020; 8(8):539. doi:10.21037/atm.2020. 02.85
25. Hiraoka A, Kumada T, Kudo M, et al. Albumin-bilirubin (ALBI) grade as part of the evidence-based clinical practice guideline for HCC of the Japan Society of Hepatology: a comparison with the Liver Damage and Child-Pugh classifications. Liver Cancer. 2017;6(3):204-215. doi:10. 1159/000452846
26. Zhang ZQ, Xiong L, Zhou JJ, et al. Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC. World J Surg Oncol. 2018; 16(1):208. doi:10.1186/s12957-018-1500-9
27. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317-1325. doi:10.1002/hep.21178
28. Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46(1):32-36. doi:10.1002/hep. 21669
29. Anstee QM, Berentzen TL, Nitze LM, et al. Prognostic utility of Fibrosis-4 Index for risk of subsequent liver and cardiovascular events, and all-cause mortality in individuals with obesity and/or type 2 diabetes: a longitudinal cohort study. Lancet Reg Health Eur. 2023;36: 100780. doi:10.1016/j.lanepe.2023.100780
30. Hsieh YC, Lee KC, Wang YW, et al. Correlation and prognostic accuracy between noninvasive liver fibrosis markers and portal pressure in cirrhosis: role of ALBI score. PLoS One. 2018;13(12):e0208903. doi:10. 1371/journal.pone.0208903
31. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol. 2021;75(3):659-689. doi:10.1016/ j.jhep.2021.05.025
32. Xiao G, Zhu S, Xiao X, Yan L, Yang J, Wu G. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis. Hepatology. 2017;66(5):1486-1501. doi:10.1002/hep.29302
33. Rabiee A, Deng Y, Ciarleglio M, et al. Noninvasive predictors of clinically significant portal hypertension in NASH cirrhosis: Validation of ANTICIPATE models and development of a lab-based model. Hepatol Commun. 2022;6(12): 3324-3334. doi:10.1002/hep4.2091
Article available in :
Volume 3, Issue 1, 2026
Page : 9-14
https://doi.org/10.51271/JRM-0043
Article Information
Received : 07 Şub 2026
Accepted : 04 Mar 2026
Published : 09 Mar 2026
Corresponding Author :

Betül Akdal Dölek: Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkiye

[email protected]
Citation : Akdal Dölek B. Functional Liver Imaging Score on gadoxetic acid-enhanced MRI: correlation with MELD, ALBI, Child-Pugh, FIB-4, and diagnostic performance for advanced hepatic dysfunction in chronic liver disease. J Radiol Med. 2026;3(1):9-14.

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