Incorporating parenchymal heterogeneity into FLIS to improve MRI-based liver function assessment

Abstract Objectives 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. Materials and methods 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. Results 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). Conclusion 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. Critical relevance 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. Key Points 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. Graphical Abstract