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Image-based quantitative methods for liver heterogeneity (L Het ) and nodularity (L Nod ) provide helpful information for evaluating liver fibrosis; however, their combinations are not fully understood in liver diseases. We developed an integrated software for assessing L Het  and L Nod  and compared L Het  and L Nod  according to fibrosis stages in chronic liver disease (CLD). Overall, 111 CLD patients and 16 subjects with suspected liver disease who underwent liver biopsy were enrolled. The procedures for quantifying L Het  and L Nod  were bias correction, contour detection, liver segmentation, and L Het  and L Nod  measurements. L Het  and L Nod  scores among fibrosis stages (F0–F3) were compared using ANOVA with Tukey’s test. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristics (AUROC) curve. The mean L Het  scores of F0, F1, F2, and F3 were 3.49 ± 0.34, 5.52 ± 0.88, 6.80 ± 0.97, and 7.56 ± 1.79, respectively ( p  < 0.001). The mean L Nod  scores of F0, F1, F2, and F3 were 0.84 ± 0.06, 0.91 ± 0.04, 1.09 ± 0.08, and 1.15 ± 0.14, respectively ( p  < 0.001). The combined L Het  × L Nod  scores of F0, F1, F2, and F3 were 2.96 ± 0.46, 5.01 ± 0.91, 7.30 ± 0.89, and 8.48 ± 1.34, respectively ( p  < 0.001). The AUROCs of L Het , L Nod , and L Het  × L Nod  for differentiating F1 vs. F2 and F2 vs. F3 were 0.845, 0.958, and 0.954; and 0.619, 0.689, and 0.761, respectively. The combination of L Het  and L Nod  scores derived from routine MR images allows better differential diagnosis of fibrosis subgroups in CLD.

journal of clinical medicine

Assessment of Liver Fibrosis Stage Using Integrative Analysis of Hepatic Heterogeneity and Nodularity in Routine MRI with FIB-4 Index as Reference Standard