Staging liver fibrosis by using liver-enhancement ratio of gadoxetic acid-enhanced MR imaging: comparison with aspartate aminotransferase-to-platelet ratio index

Magn Reson Imaging. 2011 Oct;29(8):1047-52. doi: 10.1016/j.mri.2011.05.007. Epub 2011 Jul 19.


Objective: To compare the diagnostic ability of gadoxetic acid-enhanced hepatocyte-phase MR images with aspartate aminotransferase-to-platelet ratio index (APRI) to predict liver fibrosis stage.

Materials and methods: Our study included 100 patients who underwent gadoxetic acid-enhanced MRI and either liver biopsy or liver surgery. Liver fibrosis stage was histologically determined according to the METAVIR system: F0 (n=16), F1 (n=17), F2 (n=10), F3 (n=21) and F4 (n=36). Four measures were used as imaging-based fibrosis markers: liver-spleen contrast ratio, liver-enhancement ratio, corrected liver-enhancement ratio and spleen index. APRI represented a blood test-based fibrosis marker. The diagnostic ability of those fibrosis markers were compared through receiver-operating characteristic analysis.

Results: The area under the curve (AUC) for APRI prediction of severe fibrosis (≥F3 and F4) was significantly greater than that of corrected liver-enhancement ratio. However, corrected liver-enhancement ratio had a greater AUC for prediction of mild fibrosis (≥F1) than APRI, although the difference was insignificant.

Conclusion: Corrected liver-enhancement ratio with gadoxetic acid-enhanced MRI is correlated to the stage of liver fibrosis. APRI, however, has greater reliability for predicting severe fibrosis and cirrhosis than does the imaging-based fibrosis marker tested in this study.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Aspartate Aminotransferases / metabolism*
  • Blood Platelets / enzymology*
  • Contrast Media / pharmacology
  • Fibrosis / pathology
  • Gadolinium DTPA / pharmacology*
  • Humans
  • Liver / pathology*
  • Liver Cirrhosis / pathology*
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • ROC Curve


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Aspartate Aminotransferases
  • Gadolinium DTPA