Abstract: Objective The aim of this study was to explore the application of MR liver diffusion-weighted imaging (DWI) parameters in predicting patients with liver cirrhosis (LC) and high-risk esophageal varices (HREV). Methods The clinical data were collected from 94 patients with hepatitis B-induced LC in our hospital between August 2023 and August 2025, and all underwent gastroscopy and MR DWI to measure and record apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion-related diffusion coefficient (D^*) and perfusion fraction (f). The diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Of the 94 patients with LC, gastroscopy found mild EV in 35 cases, moderate in 33 cases and severe in 26 cases, and HREV in 46 cases (48.9%) and non-HREV(NHREV) in 48 cases (51.1%); DWI parameters differed significantly among patients with different Child-Pugh classes and with different degrees of EV(P＜0.05); ADC and D in patients with HREV were (1.1±0.2)×10^-3mm²/s and (1.0±0.1)×10^-3mm²/s,both much smaller than [(1.4±0.3)×10^-3mm²/s and (1.3±0.2)×10^-3mm²/s, respectively, P＜0.05],while D^* and f were (45.7±12.4)×10^-3mm²/s and (28.6±6.4)%,both much greater than [(32.6±10.8)×10^-3mm²/s and (21.8±5.7)%,respectively, P＜0.05] in patients with NHREV; ROC analysis showed that the sensitivity was 92.3% while the specificity was 70.8%(P＜0.05), when combination DWI parameters, e.g., ADC, D, D^* and f, any three of them reaching to cut-off-value was set to predict HREV in patients with LC. Conclusion Application of MR DWI parameters of the liver could be useful in predicting HREV in patients with LC, which might help clinicians make further decisions of interventions.

Key words: Liver cirrhosis, High-risk esophageal varices, Magnetic resonance imaging, Diffusion-weighted imaging, Apparent diffusion coefficient, True diffusion coefficient, Diagnosis