Background: Three-dimensional (3D) MR elastography (MRE) derives viscoelastic parameters that may reflect inflammation, but their frequency dependence and the influence of steatosis on inflammation grading and fibrosis staging remain unclear.

Purpose: To investigate 3D multifrequency MRE for assessing hepatic inflammation, fibrosis stage across frequencies, and the influence of steatosis.

Study Type: Prospective.

Population: Sixty-four (40 men, median age: 58 years) participants with chronic liver disease (CLD); 21 (8 men, median age:28 years) healthy volunteers.

Field Strength/Sequence: 3-T; gradient-echo sequence with mechanical vibrations at low (16.7 and 18 Hz), medium (33.4 and 36 Hz), and high (50.1 and 54 Hz) frequencies.

Assessment: In CLD participants, MRE-derived viscoelastic parameters, shear stiffness, storage modulus, loss modulus, and damping ratio were compared with histologically assessed fibrosis, inflammation, and steatosis. MRE test–retest repeatability over 10 min was evaluated in healthy volunteers.

Statistical Tests: Wilcoxon rank sum test, Spearman's correlation, multivariable regression analysis, and area under the receiver operating curve (AUROC). A p value of < 0.05 was considered statistically significant.

Results: Inflammation was significantly independently associated with damping ratio at medium frequency, which showed moderate performance for grading inflammation (AUROC = 0.76–0.83, sensitivity = 0.83–0.84, specificity = 0.70–0.79). Fibrosis staging using shear stiffness and moduli showed high diagnostic performance (AUROC = 0.82–0.95), with comparable accuracy between medium and high frequencies (p = 0.327–0.896). Steatosis was not significantly correlated with MRE overall (p = 0.212–0.459), but was significantly associated with 19% higher stiffness and 20% higher loss modulus at medium frequency in CLD participants without fibrosis or inflammation.

Data Conclusion: Medium frequency 3D MRE demonstrated an independent association with inflammation while preserving accurate fibrosis assessment. Steatosis seemed not to confound MRE-based evaluation.

Level of Evidence: 1.

Technical Efficacy: Stage 2.

Plain Language Summary: Chronic liver disease can cause both inflammation and scarring (fibrosis). Accurate assessment usually requires a biopsy, which is invasive. This study evaluated a noninvasive imaging method called three-dimensional magnetic resonance elastography (3D MRE) in patients who underwent same-day liver biopsy. The researchers tested whether different vibration frequencies could detect inflammation and fibrosis. They found that medium frequency measurements were associated with liver inflammation while still accurately identifying fibrosis. Fat accumulation in the liver did not significantly affect the results. These findings suggest that 3D MRE may help medical doctors assess liver inflammation and fibrosis noninvasively in a single examination.

Background: Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF. Methods: This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C). Results: Among the 292 patients, 25 (8.6%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P &lt; 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803). Conclusion: The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.