Value of Multimodal Imaging Quantitative Parameters for Evaluating ALBI Grades in Liver Cirrhosis

Abstract

Objective: To compare the discriminative performance of quantitative parameters derived from dual-energy computed tomography (DECT) and magnetic resonance imaging (MRI) in differentiating Albumin-Bilirubin (ALBI) grades in patients with liver cirrhosis. Methods: This single-center retrospective study included 93 participants (68 patients with cirrhosis and 25 non-cirrhotic controls). Patients with cirrhosis were stratified by ALBI grade: grade 1 (n = 25), grade 2 (n = 24), and grade 3 (n = 19). All participants underwent upper abdominal DECT and diffusion-weighted imaging (DWI). The following parameters were measured: fractional extracellular volume (fECV), arterial iodine fraction (AIF), and iodine washout ratio (IWR) from DECT; and virtual shear modulus (μDiff) from DWI. Spearman correlation analysis was used to assess associations with ALBI grade, and receiver operating characteristic (ROC) curve analysis was performed to evaluate discriminative performance for adjacent ALBI grades. Results: fECV showed the strongest correlation with ALBI grade (rₛ = 0.824, P < 0.001) and achieved the highest area under the ROC curve (AUC) values: 0.898 (95% CI: 0.802–0.971) for discriminating grade 1 from grade 2, and 0.862 (95% CI: 0.731–0.965) for discriminating grade 2 from grade 3. IWR was negatively correlated with ALBI grade (rₛ = −0.777, P < 0.001), with AUCs of 0.835 and 0.851, respectively. AIF was positively correlated (rₛ = 0.756, P < 0.001), with AUCs of 0.838 and 0.827, respectively. μDiff showed a relatively weaker correlation (rₛ = 0.645, P < 0.001), with AUCs of 0.732 and 0.800, respectively. All four parameters differed significantly between adjacent ALBI grades (all P < 0.05, Holm-corrected). Conclusions: DECT- and MRI-derived quantitative parameters can effectively differentiate ALBI grades in liver cirrhosis. fECV exhibits the best discriminative performance, while IWR and AIF may provide complementary information for assessing hepatic functional reserve.