MRE-Assessed Hepatic Stiffness Gradient Distinguishes Congestive Hepatopathy from Non-congestive Chronic Liver Disease

Motivation: Congestion and consequent fibrosis lead to increased liver stiffness in Fontan-associated liver disease (FALD). Stiffness gradient (SG) may distinguish congestive hepatopathy from other chronic liver diseases. Goal(s): To evaluate the repeatability of MRE-assessed hepatic SG and evaluate its ability to differentiate congestive (FALD) and noncongestive (MASLD) hepatopathy. Approach: Inter-reader repeatability of SG was assessed in 80 exams by ICC and Bland-Altman analysis. The group difference of SG was compared between 38 FALD and 19 MASLD patients matched by their mean liver stiffness. Results: SG has excellent repeatability (ICC=0.82, Bias=-0.0019kPa/mm). FALD has a significantly steeper SG than MASLD (-0.036 [-0.050,-0.028] vs. -0.018 [-0.027,-0.003]kPa/mm, p<0.001). Impact: FALD patients exhibit more pronounced liver stiffness gradients from the liver capsule to IVC compared to MASLD patients with similar mean liver stiffness. MRE-assessed stiffness gradient may be a promising parameter for diagnosing and monitoring congestive liver diseases.