比较计算机断层扫描容积测量（CTV）、锝99m半乳糖基血清白蛋白（99mTc-GSA）显像和锶石乙醇醚磺胺基乙三乙酸增强磁共振成像（EOB-MRI）在评估肝纤维化（LF）阶段的有效性。本回顾性研究纳入了91例接受肝切除术的连续患者，进行了术前动态CT和99mTc-GSA显像。76例患者进行了EOB-MRI。CTV用于测量总肝体积（TLV）、脾脏体积（SV），以体表面积（BSA）进行标准化，并计算出肝脾体积比值（TLV/SV）。99mTc-GSA显像提供LHL15、HH15和GSA指标。EOB-MRI中计算了肝脾比值（LSR）。在65名患者中测量了透明质酸和Ⅳ型胶原水平。采用Logistic回归和接受者操作特征（ROC）分析，确定了用于评估LF阶段和实验室数据的有用参数。根据多元Logistic回归分析，研究发现SV/BSA（比值比[OR]，1.01；95%置信区间[CI]，1.003-1.02；p = 0.011）、LSR（OR，0.06；95%CI，0.004-0.70；p = 0.026）和透明质酸（OR，1.01；95%CI，1.001-1.02；p = 0.024）是严重LF（F3-4）的独立变量。结合使用SV/BSA、LSR和透明质酸可以正确评估严重LF，其AUC为0.91，明显大于GSA指数（AUC = 0.84）、SV/BSA（AUC = 0.83）或LSR（AUC = 0.75）单独的AUC。与CTV、EOB-MRI或99mTc-GSA显像单独相比，结合CTV、EOB-MRI和透明质酸分析提高了对严重LF的估计准确性。CT容积测量、EOB-MRI和透明质酸的联合分析可以识别与肝切除术后肝衰竭和复发风险较高的严重肝纤维化。• CT容积测量中脾脏体积以体表面积归一化，EOB-MRI中肝脾比率和透明质酸是肝纤维化的独立变量。• CT容积测量和EOB-MRI能够检测到严重肝纤维化，可能与术后肝衰竭和并发症有关。• CT容积测量、锶石乙醇醚磺胺基乙三乙酸增强磁共振成像（EOB-MRI）和透明质酸的联合分析改善了严重肝纤维化的估计，相比于锝99m半乳糖基血清白蛋白显像。© 2023.作者（通过欧洲放射学学会独家授权）。

To compare the efficacy of computed tomography volumetry (CTV), technetium99m galactosyl-serum-albumin (99mTc-GSA) scintigraphy, and gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI) in estimating the liver fibrosis (LF) stage in patients undergoing liver resection.This retrospective study included 91 consecutive patients who had undergone preoperative dynamic CT and 99mTc-GSA scintigraphy. EOB-MRI was performed in 76 patients. CTV was used to measure the total liver volume (TLV), spleen volume (SV), normalised to the body surface area (BSA), and liver-to-spleen volume ratio (TLV/SV). 99mTc-GSA scintigraphy provided LHL15, HH15, and GSA indices. The liver-to-spleen ratio (LSR) was calculated in the hepatobiliary phase of EOB-MRI. Hyaluronic acid and type 4 collagen levels were measured in 65 patients. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify useful parameters for estimating the LF stage and laboratory data.According to the multivariable logistic regression analysis, SV/BSA (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.003-1.02; p = 0.011), LSR (OR, 0.06; 95%CI, 0.004-0.70; p = 0.026), and hyaluronic acid (OR, 1.01; 95%CI, 1.001-1.02; p = 0.024) were independent variables for severe LF (F3-4). Combined SV/BSA, LSR, and hyaluronic acid correctly estimated severe LF, with an AUC of 0.91, which was significantly larger than the AUCs of the GSA index (AUC = 0.84), SV/BSA (AUC = 0.83), or LSR (AUC = 0.75) alone.Combined CTV, EOB-MRI, and hyaluronic acid analyses improved the estimation accuracy of severe LF compared to CTV, EOB-MRI, or 99mTc-GSA scintigraphy individually.The combined analysis of spleen volume on CT volumetry, liver-to-spleen ratio on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI, and hyaluronic acid can identify severe liver fibrosis associated with a high risk of liver failure after hepatectomy and recurrence in patients with hepatocellular carcinoma.• Spleen volume of CT volumetry normalised to the body surface area, liver-to-spleen ratio of EOB-MRI, and hyaluronic acid were independent variables for liver fibrosis. • CT volumetry and EOB-MRI enable the detection of severe liver fibrosis, which may correlate with post-hepatectomy liver failure and complications. • Combined CT volumetry, gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI), and hyaluronic acid analyses improved the estimation of severe liver fibrosis compared to technetium99m galactosyl-serum-albumin scintigraphy.© 2023. The Author(s), under exclusive licence to European Society of Radiology.