Abstract: Objective To explore the diagnostic value of magnetic resonance imaging (MRI) combined with serum Kruppel like factor 5 (KLF5) and abnormal prothrombin (PIVKA-II) in liver focal nodular hyperplasia.Methods From March 2020 to March 2023, 146 confirmed patients with liver nodular hyperplasia treated in our hospital were regarded as subjects. Based on pathological examination as the gold standard, they were grouped into two groups according to the examination results: the liver focal nodular hyperplasia group (90 cases) and the non-liver focal nodular hyperplasia group (56 cases). Enzyme linked immunosorbent assay (ELISA) was applied to measure serum KLF5 level. Chemiluminescence method was applied to detect serum PIVKA-II level. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of serum KLF5 and PIVKA-II levels for liver focal nodular hyperplasia. Four grid table method was applied to analyze the diagnostic value of MRI combined with serum KLF5 and PIVKA-II levels for liver focal nodular hyperplasia.Results The proportion of alcohol consumption [51 (56.67%) vs. 22 (39.29%)], serum KLF5 [(4.15±1.25) ng/mL vs. (1.87±0.31) ng/mL], and PIVKA-Ⅱ [(26.43±5.33) mAu/mL vs. (19.24±4.64) mAu/mL] levels in the liver focal nodular hyperplasia group were obviously higher than those in the non-liver focal nodular hyperplasia group (P<0.05). The area under the curve (AUC) of serum KLF5 and PIVKA-Ⅱ for diagnosing liver focal nodular hyperplasia was 0.912 and 0.871, respectively, with sensitivity of 88.76% and 84.27%, the specificity of 82.14% and 83.93%, and the optimal cut-off value of 2.84 ng/mL and 21.22 mAu/mL, respectively. The MRI examination results were consistent with the gold standard (Kappa value=0.426, P value < 0.001). The results of serum KLF5 and PIVKA-II tests were consistent with the gold standard (Kappa values = 0.430, 0.438, P values < 0.001). The joint examination results of the combination of MRI, serum KLF5 and PIVKA-II had high consistency with the gold standard (Kappa value=0.709, P value < 0.001). The sensitivity and accuracy of MRI combined with serum KLF5 and PIVKA-II in diagnosing liver focal nodular hyperplasia were obviously higher than those of the individual diagnosis of MRI, serum KLF5, PIVKA-II (P<0.05).Conclusion Serum KLF5 and PIVKA-II levels are up-regulated in patients with liver focal nodular hyperplasia, and MRI combined with serum KLF5 and PIVKA-II has higher diagnostic value for disease.

Key words: Liver focal nodular hyperplasia, Magnetic resonance imaging, Kruppel like factor 5, Abnormal prothrombin