Liver Functions in Patients with Chronic Liver Disease and Liver Cirrhosis: Correlation of FLIS and LKER with PALBI Grade and APRI.

Abstract

Introduction: In chronic liver disease (CLD) and liver cirrhosis (LC), assessing hepatic function and disease severity is crucial for patient management. This study aimed to evaluate the relationship between platelet-albumin-bilirubin (PALBI) grade and aspartate aminotransferase/platelet ratio index (APRI) with the functional liver imaging score (FLIS) and liver-to-kidney enhancement ratio (LKER) using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI).

Methods: After applying exclusion criteria, 86 patients with CLD or LC who underwent Gd-EOB-DTPA-enhanced MRI between January 2018 and October 2023 were included. APRI and PALBI grades were calculated from laboratory data. FLIS was determined as the sum of three HBP imaging features (liver parenchymal enhancement, biliary excretion, and portal vein sign), with each scoring 0-2. LKER was calculated by dividing liver signal intensity by kidney intensity using region of interest (ROI) measurements. Spearman's correlation was used to assess relationships between the variables.

Results: APRI showed a weak negative correlation with both FLIS (r = -0.327, p = 0.02) and LKER (r = -0.308, p = 0.004). PALBI showed a moderate negative correlation with FLIS (r = -0.495, p = 0.001) and LKER (r = -0.554, p = 0.0001).

Discussion: FLIS and LKER moderately correlated with PALBI and weakly with APRI. LKER may be a more practical tool due to its quantitative nature. Despite limitations, combining imaging and lab-based scores could enhance liver function assessment.

Conclusion: FLIS and LKER can validate, rather than predict or exclude, liver dysfunction in CLD and LC.