Correlation of Functional Liver Imaging Score from Gadoxetic Acid–Enhanced MRI with Clinical Markers in Chronic Liver Disease

Objectives To evaluate the correlation between Functional Liver Imaging Score (FLIS), derived from gadoxetic acid–enhanced MRI, and established clinical/laboratory parameters (Child-Pugh, FIB-4, Relative Liver Enhancement [RLE], Liver-to-Spleen Index (LSI), and spleen diameter) in individuals with chronic liver disease (CLD). Materials and Methods We retrospectively analyzed 94 patients with chronic liver disease (CLD) who underwent gadoxetic acid-enhanced MRI between January 2023 and June 2025 in our hospital. FLIS, RLE, and LSI were calculated based on hepatobiliary phase imaging features. Patients were categorized into non-ACLD, cACLD, or dACLD, and classified by Child–Pugh and FIB-4 scores. ROC analysis was used to evaluate the diagnostic performance of RLE, LSI, spleen sizes and FLIS for distinguishing CP classes and FIB-4 scores. Results A total of 94 patients were categorized into non-ACLD, cACLD, and dACLD groups. Both Child–Pugh and FIB-4 scores were significantly associated with disease severity ( p < 0.001). Total FLIS scores demonstrated a statistically significant, yet moderate, correlation with clinical severity, particularly with Child–Pugh class ( p < 0.05). Among FLIS components, hepatobiliary phase (HBP) parenchymal enhancement was significantly lower in cACLD and dACLD compared to non-ACLD. FIB-4 correlated significantly with spleen size, RLE, and LSI ( p < 0.05) Conclusion FLIS showed a significant association with disease severity and may serve as a supportive imaging biomarker for liver function. Child–Pugh and FIB-4 scores demonstrated stronger and more consistent associations and remain key non-invasive tools in CLD evaluation. Additionally, RLE, LSI, and spleen size appear useful in capturing functional and structural changes, especially in conjunction with clinical indices.