Diagnostic Effectiveness of Native T1 Mapping in Staging Liver Fibrosis According to Magnetic Resonance Imaging

Background. Liver fibrosis represents a structural manifestation of chronic liver diseases and, with progression, leads to the development of cirrhosis and related complications. Native liver T1 mapping is considered a quantitative magnetic resonance imaging (MRI) technique reflecting the severity of fibrotic changes; however, its diagnostic performance may be influenced by liver tissue composition, including steatosis.

Objective: to evaluate the diagnostic performance of native T1 mapping for liver fibrosis staging and to assess the impact of steatosis on its diagnostic characteristics.

Material and methods. This retrospective study included 241 patients who underwent abdominal MRI with acquisition of native liver T1 relaxation maps using the MOLLI 4(1)3(1)2 and MOLLI 5(3)3 protocols with pulse-triggered cardiac synchronization during a single breath-hold. Reference fibrosis staging (METAVIR F0–F4) was established based on integrated clinical, laboratory, and instrumental data. An additional stratification was performed according to the presence of hepatic steatosis, determined based on proton density fat fraction values. Patients with evidence of hepatic iron overload were excluded from the analysis. The relationship between native liver T1 values and fibrosis stage was assessed using correlation analysis, and intergroup comparisons were performed across fibrosis stages. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis for the identification of clinically significant fibrosis (≥F2), advanced fibrosis and cirrhosis (≥F3), and cirrhosis (F4). Statistical analysis was performed using nonparametric methods. Multiple comparisons were controlled using the Benjamini–Hochberg procedure, and results were considered statistically significant at false discovery rate (FDR) <0.05.

Results. A statistically significant positive correlation was observed between native liver T1 values and fibrosis stage (ρ=0.779 for MOLLI 4(1)3(1)2 and ρ=0.792 for MOLLI 5(3)3; p<0.001; FDR<0.05). Median T1 values increased progressively from F0 to F4, and differences between all adjacent stages remained significant after FDR correction. ROC analysis demonstrated high diagnostic performance of native T1 mapping for fibrosis stratification: AUROC values for ≥F2 were 0.909 and 0.919; for ≥F3, 0.946 and 0.954; and for F4, 0.972 and 0.981 for MOLLI 4(1)3(1)2 and MOLLI 5(3)3, respectively. In the presence of steatosis, diagnostic performance decreased for ≥F2, whereas no statistically significant differences between subgroups were observed for ≥F3 and F4 (p>0.05). These findings indicate a modifying effect of steatosis primarily at early stages of fibrosis discrimination.

Conclusion. Native liver T1 mapping using MOLLI 4(1)3(1)2 and MOLLI 5(3)3 protocols is an informative quantitative MRI technique for fibrosis staging. Diagnostic performance increases from ≥F2 to ≥F3 and reaches its highest level in cirrhosis. The presence of steatosis reduces discriminatory performance for ≥F2, thereby defining the limitations of the technique and supporting its use as part of a multiparametric MRI approach in patients with chronic liver diseases.

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