Incorporación de la heterogeneidad del parénquima en FLIS para mejorar la evaluación de la función hepática basada en...

To assess the correlation between the functional liver imaging score (FLIS) and FibroScan^®-derived fibrosis stage, and to determine whether incorporating parenchymal heterogeneity (FLIS-H) improves its association with fibrosis and clinical scores.

This retrospective single-centre study included 113 patients who underwent FibroScan^® and hepatocyte-specific contrast-enhanced MRI within a median interval of 4 days. FLIS was calculated, and the parenchymal heterogeneity score was added to FLIS (FLIS-H; range 0-8). Inter-reader agreement was evaluated using a two-way random-effects intraclass correlation coefficient (ICC). Correlations between FLIS/FLIS-H and fibrosis stage/clinical scores (Child-Pugh, MELD, ALBI) were assessed using Spearman's rank correlation. Steiger's z-test and Zou's method were used to compare correlations.

A total of 113 patients (67 men; mean age 56.6 ± 13.5 years) were evaluated. Inter-reader agreement was excellent for FLIS (ICC 0.994; 95% CI: 0.975-1.000), heterogeneity (ICC 0.949; 95% CI: 0.901-0.984), and FLIS-H (ICC 0.974; 95% CI: 0.957-0.989). FLIS showed significant negative correlations with Child-Pugh (ρ = -0.2664, p = 0.0087), ALBI (ρ = -0.3076, p = 0.0022), and fibrosis stage (ρ = -0.3207, p < 0.001). FLIS-H demonstrated stronger correlations with Child-Pugh (ρ = -0.4167, p < 0.001), ALBI (ρ = -0.5243, p < 0.001), MELD (ρ = -0.2360, p = 0.020), and fibrosis stage (ρ = -0.5270, p < 0.001). Steiger's z-test confirmed that correlations were significantly improved with FLIS-H for ALBI (z = -3.03, p = 0.0025), Child-Pugh (z = -2.01, p = 0.045), and fibrosis stage (z = -2.90, p = 0.0038).

FLIS correlates significantly with fibrosis stage and clinical scores. Incorporating parenchymal heterogeneity into FLIS enhances these associations and may provide a superior method for liver assessment.

This study introduces a modified FLIS version (FLIS-H) that integrates parenchymal heterogeneity and demonstrates superior correlation with elastography-derived fibrosis stages and clinical scoring systems, offering a practical improvement for non-invasive assessment in routine practice.

FLIS has no reported correlation with elastography-based liver fibrosis staging. Parenchymal heterogeneity is not included as a parameter in the standard FLIS. Integrating heterogeneity improves correlation with fibrosis stage and clinical scores. FLIS-H enables fast, reliable, structure-function liver assessment in clinical radiology.