Quantitative assessment of liver graft function using functional automated whole-liver score derived from gadoxetic acid-enhanced MRI: a prospective cohort study.

OBJECTIVES Accurate and timely assessment of liver graft function is of great significance for the survival of liver grafts and liver transplant recipients. This study aimed to investigate the correlation between functional automated whole-liver score (FAWLS) system derived from gadoxetic acid-enhanced MRI and quantitative measurements of liver graft function. Additionally, it sought to determine the utility of FAWLS in evaluating the severity of liver graft injury and monitoring treatment response following therapy, through an association analysis with liver biopsy findings to validate its effectiveness as a non-invasive diagnostic tool.

METHODS Between July 2021 and September 2023, 172 liver transplant recipients underwent liver MRI at a 3 T system, which included T1 mapping and HISTO MRS in this prospective cohort study. The Albumin-Bilirubin (ALBI) score was utilized to quantitatively evaluate liver graft function. T1 maps were obtained before and 20 minutes after the injection of gadoxetic acid (0.025 mmol/kg). This study assessed the relationship between the ALBI score and various MRI parameters, including pre- and post-contrast liver T1 values, FAWLS, liver volume, and functional liver imaging score (FLIS). Diagnostic performance of the FAWLS in identifying patients with an ALBI score greater than -2.6. Utilized the areas under the receiver operating characteristic curve to compare across other parameters.

RESULTS FAWLS exhibited a negative correlation with ALBI (r = – 0.72; P< .001). Participants with ALBI scores of -2.6 or lower showed significant differences FAWLS, post-contrast T1 liver, and △T1live compared to those with ALBI scores greater than -2.6. FAWLS demonstrated superior performance in detecting ALBI of greater than -2.6 compared to liver volume (0.83 vs 0.59; P< .0001), △T1liver (0.83 vs 0.76; P = 0.03), and FLIS (0.83 vs 0.65; P = 0.01). Significant alterations in FAWLS were observed between pre-treatment and post-treatment measurements.

CONCLUSION FAWLSs are negatively correlated with liver function based on ALBI scores and provide good diagnostic accuracy in identifying patients with ALBI of greater than -2.6. Additionally, FAWLS is valuable for monitoring treatment response after therapy in these individuals.