Assessing the liver function provides valuable information to evaluate surgical risk and plan accordingly. Current studies focus on whole liver function evaluation. However, assessment of segmental liver function is equally important in the clinical practice. The purpose of this study was to investigate whether Gd-EOB-DTPA-enhanced MRI can evaluate the liver function of each segment by using T1 mapping at 3 Tesla MRI. One hundred three patients were classified into one of 4 groups: a normal liver function (NLF) group (n = 38), a liver cirrhosis with Child-Pugh A (LCA) group (n = 33), a liver cirrhosis with Child-Pugh B (LCB) group (n = 21), and a liver cirrhosis with Child-Pugh C (LCC) group (n = 11). All patients underwent Gd-EOB-DTPA-enhanced MRI scans. T1 relaxation times were measured on the liver superimposing T1 mapping images. Reduction rate (△%) of T1 relaxation time of the liver parenchyma were calculated. After 20 min of Gd-EOB-DTPA enhancement, the T1 relaxation time of all liver segments in the LCC group were different from those in all the other groups, and more liver segments from the LCB and LCA groups different from the NLF group (p < 0.05). For the LCB group, the areas under the receiver operating characteristic curves (AUCs) of different liver segments for hepatobiliary phase (HBP) were 0.654-0.904 on T1 relaxation time, and 0.709-0.905 on △%. For the LCC group, the AUCs of different liver segments for HBP were 0.842–0.997 on T1 relaxation time, and 0.887–0.990 on △%. For LCB patients, segmental liver function evaluation is possible using Gd-EOB-DTPA-enhanced MRI T1 mapping. For LCC patients, all liver segments can be used to evaluate liver function and both T1 relaxation time and the △% of T1 relaxation time have good diagnostic performance.

AIM: To investigate the value of the LR-5, which is based on hepatobiliary phase (HBP) hypointensity, for small hepatocellular carcinoma (sHCC) using LI-RADS v2018 criteria. MATERIALS AND METHODS: From January 2015 to December 2021 in institution 1, and from January 2019 to February 2022 in institution 2, 239 patients at high risk for hepatocellular carcinoma (HCC) underwent contrast-enhanced MRI. Two radiologists independently evaluated the imaging features and classified them according to LI-RADS v2018 criteria, calculating the diagnostic performance of LR-5 based on consensus data. LI-RADS-m1: HBP hypointensity was used as an additional major feature along with the LI-RADS v2018. LI-RADS-m2: HBP hypointensity replaced nonperipheral "washout" in the portal venous phase. The definition of LR-DN was nodules pathologically diagnosed as high-grade dysplastic nodules (HGDN) were recategorized as LR-DN. The diagnostic performance of LR-5 was recalculated. The diagnostic performance of the LR-5 was compared using McNemar's test. RESULTS: Using LI-RADS v2018, LI-RADS-m1, and LI-RADS-m2 criteria for LR-5, the sensitivities were 82.67%, 86.22%, and 88.44%, the specificities were 82.00%, 66.00%, and 54.00%, and the accuracies were 82.55%, 82.55%, and 82.18%, respectively. After the addition of the LR-DN, the sensitivities of LR-5 in the above diagnostic model remained unchanged, with accuracies of 84.36%, 87.27%, and 88.36% and specificities of 92.00%, 92.00%, and 88.00%, respectively. CONCLUSIONS: HBP hypointensity may improve the sensitivity of LR-5. We attempted to propose the LR-DN, HBP hypointensity may be used as a complement to washout as an additional major feature without significantly decreasing specificity.