Comparison of magnetic resonance functional imaging score and fibroscan score in liver parenchymal evaluation

Background: FibroScan and the functional liver imaging score (FLIS) are non-invasive radiological assesment methods. The degree of liver fibrosis is evaluated by elastography in FibroScan. In FLIS system, liver signal intensity is compared with renal parenchyma and portal vein in the hepatobiliary phase, and additionally, the excretion of contrast material into the bile ducts during the hepatobiliary phase is evaluated. Liver parenchymal heterogeneity is not used as a parameter in this scoring system. However, radiological parenchymal heterogeneity is considered one of the important indicators of liver disease. This study aimed to evaluate the correlation between FLIS and FibroScan-derived fibrosis grade as well as clinical scoring systems (Child-Pugh, ALBI, and MELD). Additionally, the FLIS-H, in which parenchymal heterogeneity is integrated, was introduced, its correlation with the fibrosis grade and clinical scores were evaluated. Methods: Patients who underwent abdominal MRI with Gd-EOB-DTPA and FibroScan were included in the study. FLIS, liver paranchymal heterogenity with or without capsular retraction and based on these parameters FLIS-H were calculated. Child-Pugh, ALBI, MELD score and fibrosis grade based on FibroScan evaluation were noted. The correlations with clinical scoring systems, fibrosis grade and FLIS as well as FLIS-H were evaluated using Spearman's rank correlation coefficient. Statistical comparisons of FLIS and FLIS-H correlations with other parameters were performed using Steiger's z-test and Zou's 95% confidence interval method. Results: A total of 113 patients were included in the final evaluation. FLIS showed significant negative correlations with Child-Pugh (ρ = -0.2664, p = 0.0087), ALBI (ρ = -0.3076, p = 0.0022), and fibrosis grade (ρ = -0.3207, p < 0.001). However, FLIS-H demonstrated significantly stronger correlations with Child-Pugh (ρ = -0.4167, p < 0.001), ALBI (ρ = -0.5243, p < 0.001), and fibrosis grade (ρ = -0.5270, p < 0.001) compared to FLIS (p < 0.05 for all). FLIS-H also showed significant negative correlation with MELD (ρ = -0.2360, p = 0.0199), however there was no significant difference between FLIS and FLIS-H in terms of this correlation (p = 0.3711). Conclusion: A statistically significant correlation was observed between FLIS and FibroScan fibrosis degree and also clinical scores. FLIS-H, by integration of parenchymal heterogeneity parameter into FLIS, demonstrated improved correlations with clinical scores and FibroScan fibrosis grade. Additionally, adding heterogeneity to scoring in individuals with the same FLIS increased the correlation coefficient with fibrosis degree in functional assessment. Therefore, FLIS-H can be considered as a more comprehensive tool for evaluating liver parenchma and function. Its ease of integration into existing evalation protocols makes FLIS-H a practical and more accurate alternative method. Its clinical benefit and accuracy need to be validated in future prospective, multicentric studies.