Quantitative Assessment of Liver Function Using the Liver Enhancement Ratio on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging in Chronic Liver Disease

BACKGROUND/AIMS: Noninvasive assessment of hepatic functional reserve remains a clinical challenge in patients with chronic liver disease (CLD). This study aimed to quantify the association between liver enhancement ratio (LER) and standard biochemical liver function scores and to determine clinically meaningful cutoff values for functional stratification. MATERIALS AND METHODS: This retrospective study included 187 subjects (78 with CLD and 109 controls) who underwent gadoxetic acid- enhanced magnetic resonance imaging (MRI). Signal intensities from 5 liver segments were measured on precontrast and hepatobiliaryphase images to calculate LER. LER values were compared between groups and across liver function categories using nonparametric tests and correlated with model for end-stage liver disease (MELD), albumin-bilirubin (ALBI), and fibrosis-4 (FIB-4) scores. RESULTS: LER was significantly lower in the CLD group than in controls (P < .001). The optimal threshold for discriminating CLD from normal hepatic parenchyma was 1.01, with an area under the curve (AUC) of 0.83 (95% CI, 0.76-0.89). As hepatic functional impairment progressed, LER demonstrated a stepwise decline and showed moderate inverse correlations with MELD (ρ = -0.439, P < .001), ALBI (ρ = -0.579, P < .001), and FIB-4 (ρ = -0.421, P < .01). For identification of ALBI grade 2 or higher, an LER cutoff of 0.72 yielded an AUC of 0.84 (95% CI, 0.77-0.89). For prediction of MELD scores of 10 or higher, an LER threshold of 0.62 yielded an AUC of 0.73. CONCLUSION: LER is a reproducible quantitative MRI biomarker that demonstrates moderate correlations with established biochemical and clinical measures of liver function and provides clinically interpretable cutoff values for CLD detection and functional grading. Cite this article as: Akdal Dolek B, Tekdemir H, Sahin S, Camur E, Baykan AH, Okten RS. Quantitative assessment of liver function using the liver enhancement ratio on gadoxetic acid-enhanced magnetic resonance imaging in chronic liver disease. Turk J Gastroenterol. 2026;37(8):891-899.