Purpose <p>To evaluate the association of the Functional Liver Imaging Score (FLIS), derived from gadoxetic acid–enhanced MRI (GA-MRI), with clinical and imaging markers of liver function and disease severity in patients with chronic liver disease (CLD), and to determine whether FLIS primarily reflects hepatocellular function or overall disease severity.</p> Methods <p>Ninety-four patients with CLD who underwent GA-MRI between January 2023 and June 2025 were retrospectively analyzed. FLIS, Relative Liver Enhancement (RLE), and Liver-to-Spleen Index (LSI) were calculated from hepatobiliary-phase images. Patients were classified according to disease severity (non-ACLD, cACLD, and dACLD), Child–Pugh class, and FIB-4 score. Associations among FLIS, quantitative imaging parameters, and clinical severity markers were evaluated using correlation and group-comparison analyses.</p> Results <p>Both Child–Pugh class and FIB-4 score were significantly associated with disease severity (<i>p</i> &lt; 0.001). FLIS demonstrated a significant association with Child–Pugh class (<i>p</i> &lt; 0.001), with higher scores observed in patients with better preserved liver function. Among FLIS components, hepatobiliary-phase parenchymal enhancement differed significantly across disease severity groups. FLIS correlated positively with RLE and LSI (both <i>p</i> &lt; 0.001). Effect size analysis showed that FIB-4 and spleen size had stronger associations with disease severity than FLIS.</p> Conclusion <p>FLIS was associated primarily with markers of hepatocellular function, particularly Child–Pugh class, whereas FIB-4 and spleen size showed stronger relationships with overall disease severity. These findings suggest that FLIS may be used as a complementary imaging biomarker of hepatocellular function, but should not replace established clinical indices such as Child–Pugh and FIB-4.</p> Trial registration <p>Not applicable. This study is a retrospective observational study and did not involve a prospective health care intervention.</p>