Intrahepatic diffuse periportal hyperintensity patterns on hepatobiliary phase of gadoxetate-enhanced MRI: a non-invasive imaging biomarker for clinical stratification of liver injury.

Abstract

Purpose: To evaluate the clinicoradiological significance of intrahepatic periportal hyperintensity (PHI) detected by gadoxetate-enhanced hepatobiliary phase (HBP) MRI and T2-weighted imaging (T2WI), and to assess its potential as a noninvasive imaging biomarker for clinical stratification of liver injury in patients with cirrhosis.

Methods: This retrospective study included 37 cirrhotic patients with intrahepatic diffuse PHI on HBP imaging, who underwent gadoxetate-enhanced MRI between October 2019 and November 2023. PHI patterns were classified into two groups based on the spatial concordance between periportal enhancement areas on HBP and periportal hyperintense areas on T2WI. The matching group (Type A, n = 21) demonstrated complete spatial overlap between the two sequences. The mismatching group, comprised Type B (n = 11), in which PHI on HBP was immediately outside of that on T2WI, and Type C (n = 5), in which PHI was present on HBP but absent on T2WI. Clinical etiologies and liver biochemical markers (ALT, AST, GGT, TBil, DBil, ALP, Alb, TP) were compared across PHI subtypes.

Results: Type A PHI was predominantly associated with acute liver injury (e.g., acute viral hepatitis flares, drug-induced liver injury, autoimmune hepatitis), characterized by a strong ALT-AST correlation (r = 0.95, P < 0.001) and significantly elevated levels of ALT, AST, GGT, TBil, and DBil (all P < 0.001). In contrast, Types B and C PHI were primarily linked to chronic fibrotic conditions (e.g., HBV/HCV-related cirrhosis, primary biliary cholangitis, and primary sclerosing cholangitis), showing a strong TBil-DBil correlation (r = 0.95, P < 0.001) and moderately elevated ALP and Alb levels (P = 0.027 and P = 0.017, respectively). Receiver operating characteristic (ROC) analysis identified DBil > 37.5 μmol/L as the optimal threshold for differentiating Type A from Types B/C PHI (AUC = 0.922; sensitivity = 86.7%, specificity = 100%). Notably, HBP-doughnut nodules without arterial-phase hyperenhancement (APHE) were exclusively observed in the mismatching group (Type B: 4/11; Type C: 3/5), further supporting their association with chronic fibrotic changes.

Conclusion: PHI phenotyping based on HBP-T2WI spatial concordance enables accurate, noninvasive differentiation between acute inflammatory and chronic fibrotic liver injury in cirrhotic patients. When integrated with the DBil threshold, this imaging-based approach provides as a robust biomarker for clinical stratification of liver injury and may facilitate individualized diagnosis and therapeutic decision-making in chronic liver disease.