Quantitative stratification of liver cirrhosis according to Child–Pugh classes based on magnetic resonance imaging

Background. Objective noninvasive stratification of liver cirrhosis severity remains an important task in radiological diagnostics. Quantitative magnetic resonance imaging (MRI) techniques, including native T1 mapping and extracellular volume (ECV) fraction enable assessment of parenchymal structural remodeling and the severity of portal hypertension; however, their concordance with the clinical classification based on the Child-Pugh score has not been sufficiently investigated.

Objective. To comparatively evaluate the diagnostic performance of native T1 mapping and extracellular volume fraction of the liver and spleen for stratification of cirrhosis according to Child-Pugh classes.

Materials and Methods. This retrospective study included 65 patients with liver cirrhosis examined on a high-field 1.5 T Ingenia Ambition S scanner (Philips). All patients underwent multiparametric MRI with quantitative assessment of native T1 mapping and extracellular volume fraction of the liver and spleen. Stratification was performed according to Child-Pugh classes A, B, and C. Intergroup differences were assessed using the Kruskal-Wallis test with pairwise comparisons by the Mann-Whitney test. Diagnostic performance was evaluated using ROC analysis with calculation of AUROC and 95% confidence intervals (bootstrap, 2000 iterations) and comparison of curves by the DeLong test. Multiple comparisons were adjusted using the Benjamini-Hochberg procedure (FDR <0.05).

Results. The most pronounced and statistically robust differences between Child-Pugh classes were observed for hepatic ECV (H = 38.87; FDR = 0.001; ε² = 0.595). Splenic ECV also demonstrated interclass differences (FDR = 0.002; ε² = 0.199), although statistical robustness was not preserved when discriminating adjacent classes B-C. Native liver T1 mapping showed nominal intergroup significance without preservation after FDR correction (FDR = 0.061; ε² = 0.067), whereas splenic T1 mapping revealed no differences (FDR = 0.952). In all pairwise comparisons, the highest AUROC values were obtained for hepatic ECV (0.921-1.000), significantly exceeding other parameters (p <0.05, DeLong test). The strongest correlation with the total Child-Pugh score was observed for hepatic ECV (ρ = 0.761; FDR <0.001).

Conclusion. Among quantitative MRI parameters, hepatic extracellular volume fraction demonstrates the greatest stability and the highest concordance with the clinical stratification of cirrhosis according to the Child-Pugh classification. Splenic extracellular volume fraction shows lower AUROC values than hepatic extracellular volume fraction; however, it outperforms native T1 mapping of the liver and spleen in discriminating classes A-B and A-C. When comparing classes B and C, the diagnostic performance of splenic extracellular volume fraction decreases, whereas native T1 mapping of the liver and spleen is characterized by lower AUROC values for discrimination between these classes.