Multiparametric gadoxetic acid-enhanced magnetic resonance imaging (MRI) biomarkers demonstrate stage-dependent associations in chronic liver disease.

AIM: The aim of the study is to characterise the stage-dependent behaviour of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI) functional indices and volumetric biomarkers across clinically defined stages of chronic liver disease (CLD) using the EASL framework. MATERIALS AND METHODS: In this retrospective study, 140 adults with clinically or histopathologically confirmed CLD who underwent GA-MRI between March 2020 and June 2025 were categorised as nonadvanced CLD (NACLD; n = 18), compensated advanced CLD (CACLD; n = 97), or decompensated advanced CLD (DACLD; n = 25). Relative liver enhancement (RLE), contrast uptake index (CUI), liver-to-spleen index (LSI), and hepatocellular uptake index (HUI) were calculated from unenhanced and 20-minute hepatobiliary-phase images. Liver and spleen volumes were estimated using ellipsoid models. Group differences were assessed using Kruskal-Wallis and Dunn-Bonferroni tests. Receiver operating characteristic (ROC) analysis evaluated stage separation, and reproducibility was assessed using intraclass correlation coefficients (ICC). RESULTS: Uptake-focused indices differed significantly across stages and correlated negatively with disease severity (HUI ρ = -0.250; LSI ρ = -0.228; both P ≤ 0.007). For separating NACLD from more advanced disease, spleen volume showed the highest descriptive performance (area under the curve [AUC] = 0.820; 95% confidence interval [CI]: 0.712-0.927), followed by HUI (AUC = 0.721; 95% CI: 0.592-0.851) and LSI (AUC = 0.709; 95% CI: 0.569-0.849). Enhancement-based parameters showed limited stage-associated differentiation, whereas RLE demonstrated modest performance for identifying DACLD (AUC = 0.662; 95% CI: 0.547-0.780). Inter-reader agreement was good-to-excellent for RLE, CUI, HUI, and volumetry (ICC = 0.854-0.961) and moderate for LSI (ICC = 0.714). CONCLUSION: GA-MRI uptake indices and spleen volume show complementary stage-dependent associations across clinical CLD stages, supporting a multiparametric descriptive approach. External validation with haemodynamic reference standards is warranted.