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

## TL;DR

This study improves MRI-based liver function assessment by incorporating parenchymal heterogeneity into a scoring system called FLIS.

## Contribution

The novel FLIS-H score integrates parenchymal heterogeneity, enhancing correlations with liver fibrosis and clinical scores.

## Key findings

- FLIS-H showed stronger correlations with fibrosis stage and clinical scores than standard FLIS.
- Incorporating parenchymal heterogeneity significantly improved associations with Child–Pugh, ALBI, and MELD scores.
- FLIS-H provides a fast and reliable method for liver assessment in clinical radiology.

## Abstract

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.

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.