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Objectives To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study. Methods A total of 359 patients who underwent gadoxetic acid–enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses. Results There was a significant positive correlation between LSR and albumin (rho = 0.193;  p  &lt; 0.001), platelet counts (rho = 0.148;  p  = 0.004), and sodium (rho = 0.161;  p  = 0.002); and a negative correlation between LSR and total bilirubin (rho = −0.215;  p  &lt; 0.001) and AST (rho = −0.191;  p  &lt; 0.001). Multivariate analysis confirmed independent significance for each of albumin ( p  = 0.022), total bilirubin ( p  = 0.045), AST ( p  = 0.031), platelet counts ( p  = 0.012), and sodium ( p  = 0.006). The presence of ascites (1.47 vs. 1.69,  p  &lt; 0.001) and varices (1.55 vs. 1.69,  p  = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408,  p &lt;  0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33,  p  = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = −0.137;  p  = 0.013). However, one scanner brand was significantly associated with lower LSR ( p  &lt; 0.001). Conclusions The liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands. Key Points • The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI and liver function is consistent in a multicenter-multivendor cohort.  • Signal intensity–based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function.  • However, absolute values might change between vendors.

european radiology

Correlation of liver enhancement in gadoxetic acid–enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial