Predictive Value of MRI Functional Liver Imaging Score and Spontaneous Portal Shunt for First Decompensation in Patients With Chronic Hepatitis B.

Abstract

Objective: To investigate the predictive value of Gd-EOB-DTPA enhanced MRI functional liver imaging score and spontaneous portal shunt on the occurrence of first hepatitis decompensation in patients with chronic hepatitis B (CHB).

Methods: Clinical and MRI data of 443 patients with CHB who received Gd-EOB-DTPA enhanced MRI scanning from October 2019 to October 2022 were retrospectively collected. All patients had a complete clinical laboratory examination 1 week before and after MR examination. According to the FIB-4 score and Child-Pugh(CP) grading criteria, the patients were divided into 4 groups: CLD group, CPA group, CPB group, and CPC group. The correlation between clinical laboratory indicators such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and imaging parameters such as functional liver imaging score (FLIS), spontaneous portosystemic shunt (SPSS), splenic craniocaudal diameter (SCCD), portal vein width and splenic vein width of patients in different groups was compared. Intragroup correlation coefficient (ICC) was used to evaluate the consistency of FLIS, SPSS and SCCD results among different observers. The ROC curve was used to compare the diagnostic efficiency of each imaging parameter for different groups of patients. The laboratory and imaging parameters that differed across groups were analyzed using Cox regression to evaluate the predictive efficacy of each parameter for the occurrence of first liver decompensation in patients with high-risk CHB in the CLD group and the CPA and CPB groups.

Results: FLIS and its 3 parameters (EnQS, ExQS, and PVQS) were moderately strongly correlated with clinical groups (r=-0.370 to -0.543, P<0.001). The consistency of FLIS and its 3 quantitative parameters among different observers was high (r=0.965, P<0.001). SCCD and AUC of 0.844 (95% CI: 0.792-0.896) were the optimal parameters for distinguishing LC between the CLD group and the CPA group. The best FLIS criteria for predicting LC in CLD/CPA groups and for predicting LC in CPA/B groups were ≥4. The AUC for the differentiation of LC from CPB/C in the CLD/CPA groups was 0.801 (95% CI: 0.759-0.843), while the AUC for CPB and CPC was 0.858 (95% CI: 0.813-0.903). FLIS is not an independent predictor of first hepatitis decompensation in patients with CHB. Univariate analysis showed that SPSS, SCCD≥14.36 cm, age, and AST were independent risk factors for first hepatitis decompensation. The dichotomy of SPSS combined with SCCD can provide a better predictor of the first hepatitis decompensation event.

Conclusion: FLIS has the best diagnostic efficacy in classifying liver function in patients with CHB. SPSS and SCCD have high predictive value in predicting the first hepatitis decompensation event in the CLD group and the CPA and CPB groups.