NATIVE T1 mapping and liver and splenic extracellular volume fraction in the stratification of liver cirrhosis according to Child-Pugh classes: a retrospective study

INTRODUCTION: Liver cirrhosis represents the end stage of chronic liver diseases and is associated with the development of portal hypertension, leading to alterations in quantitative magnetic resonance (MR) parameters of the liver and spleen. Noninvasive techniques, including native T1 mapping and extracellular volume fraction (ECV) calculation, are considered promising tools for disease severity stratification; however, their comparative diagnostic performance in classifying patients according to the Child-Pugh grading system remains insufficiently investigated.

OBJECTIVE: To evaluate and compare the diagnostic performance of native T1 mapping and liver and splenic extracellular volume fraction for stratifying liver cirrhosis according to Child-Pugh classes.

MATERIALS AND METHODS: This retrospective study included 50 patients with confirmed liver cirrhosis who underwent multiparametric magnetic resonance imaging (MRI) with native T1 mapping (MOLLI 4(1)3(1)2 and 5(3)3 protocols) and calculation of liver and spleen extracellular volume fraction (ECV). Patients were stratified according to Child-Pugh classes: A (n=31), B (n=13), and C (n=6).

Statistics: Intergroup analysis was performed using the Kruskal-Wallis and Mann-Whitney tests with Benjamini-Hochberg correction (FDR), along with Spearman correlation analysis and ROC analysis with calculation of the area under the curve (AUROC) and pairwise comparison of ROC curves using the DeLong test.

RESULTS: Statistically significant intergroup differences were observed for all quantitative MRI parameters (p≤0.002; FDR <0.05). Liver extracellular volume fraction (ECV) demonstrated the highest discriminative performance (AUROC 1.000 for A vs C; 0.985 and 0.954 for A vs B; 0.986 for B vs C). Native liver T1 mapping showed moderate diagnostic efficiency (AUROC 0.728–0.893). Native spleen T1 mapping yielded lower and more variable AUROC values (0.436–0.857). Spleen ECV was inferior to liver ECV in diagnostic performance (AUROC 0.812–0.971). The strongest correlation with the total Child-Pugh score was observed for liver ECV (r 0.879–0.892; p<0.001).

DISCUSSION: The findings indicate higher specificity of liver ECV compared with integral native T1 mapping parameters in reflecting the functional severity of cirrhosis according to the Child-Pugh classification. Spleen ECV primarily reflects hemodynamic manifestations of portal hypertension and is less closely associated with progression of hepatocellular insufficiency. 

CONCLUSION: Liver ECV is the most accurate and informative quantitative MR parameter for stratifying cirrhosis according to Child-Pugh classes, outperforming native liver T1 mapping, spleen ECV, and spleen T1 mapping in diagnostic value.

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