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Intravoxel incoherent motion diffusion weighted imaging for preoperative evaluation of liver regeneration after hepatectomy in hepatocellular carcinoma

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To explore whether intravoxel incoherent motion (IVIM) parameters could evaluate liver regeneration preoperatively.

Methods

A total of 175 HCC patients were initially recruited. The apparent diffusion coefficient, true diffusion coefficient (D), pseudodiffusion coefficient (D*), pseudodiffusion fraction (f), diffusion distribution coefficient, and diffusion heterogeneity index (Alpha) were measured by two independent radiologists. Spearman’s correlation test was used to assess correlations between IVIM parameters and the regeneration index (RI), calculated as 100% × (the volume of the postoperative remnant liver − the volume of the preoperative remnant liver) / the volume of the preoperative remnant liver. Multivariate linear regression analyses were used to identify the factors for RI.

Results

Finally, 54 HCC patients (45 men and 9 women, mean age 51.26 ± 10.41 years) were retrospectively analyzed. The intraclass correlation coefficient ranged from 0.842 to 0.918. In all patients, fibrosis stage was reclassified as F0–1 (n = 10), F2–3 (n = 26), and F4 (n = 18) using the METAVIR system. Spearman correlation test showed D* (r = 0.303, p = 0.026) was associated with RI; however, multivariate analysis showed that only D value was a significant predictor (p < 0.05) of RI. D and D*showed moderate correlations with fibrosis stage (r = −0.361, p = 0.007; r = −0.457, p = 0.001). Fibrosis stage showed a negative correlation with RI (r = −0.263, p = 0.015). In the 29 patients who underwent minor hepatectomy, only the D value showed a positive association (p < 0.05) with RI, and a negative correlation with fibrosis stage (r = −0.360, p = 0.018). However, in the 25 patients who underwent major hepatectomy, no IVIM parameters were associated with RI (p > 0.05).

Conclusions

The D and D* values, especially the D value, may be reliable preoperative predictors of liver regeneration.

Key Points

• The D and D* values, especially the D value, derived from IVIM diffusion-weighted imaging may be useful markers for the preoperative prediction of liver regeneration in patients with HCC.

• The D and D* values derived from IVIM diffusion-weighted imaging show significant negative correlations with fibrosis, an important predictor of liver regeneration.

• No IVIM parameters were associated with liver regeneration in patients who underwent major hepatectomy, but the D value was a significant predictor of liver regeneration in patients who underwent minor hepatectomy.

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Abbreviations

ADC:

Apparent diffusion coefficient

ALB:

Albumin

Alpha:

Diffusion heterogeneity index

CT:

Computed tomography

D* :

Pseudodiffusion coefficient

D:

True diffusion coefficient

DDC:

Diffusion distribution coefficient

f :

Pseudodiffusion fraction

HCC:

Hepatocellular carcinoma

ICC:

Intraclass correlation coefficient

IVIM:

Intravoxel incoherent motion

LAVA:

Liver acceleration volume acquisition

LR:

Liver regeneration

LVpost:

The volume of the postoperative remnant liver

LVpre:

The volume of the preoperative remnant liver

MRE:

Magnetic resonance elastography

NEX:

Number of excitations

PHRR:

The parenchymal hepatic resection rate

RI:

Regeneration index

SWE:

Shear wave elastography

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Funding

This study has received funding by China Postdoctoral Science Foundation (2021M692289), Science and Technology Support Program of Sichuan Province (Grant number 2021YFS0144, Grant number 2021YFS0021), and Post-Doctor Research Project, West China Hospital, Sichuan University (Grant number 2020HXBH130).

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Author notes

  1. Qian Li and Tong Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China

    Qian Li, Tong Zhang, Feng Che, Shan Yao, Feifei Gao, Hehan Tang, Yi Wei & Bin Song

  2. GE Healthcare, MR Research China, Beijing, China

    Lisha Nie

  3. Department of Radiology, Sanya People’s Hospital, Sanya, 572000, China

    Bin Song

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  1. Qian Li
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The scientific guarantor of this publication is Dr. Bin Song.

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One of the authors (Lisha Nie) is an employee of GE Healthcare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Li, Q., Zhang, T., Che, F. et al. Intravoxel incoherent motion diffusion weighted imaging for preoperative evaluation of liver regeneration after hepatectomy in hepatocellular carcinoma. Eur Radiol 33, 5222–5235 (2023). https://doi.org/10.1007/s00330-023-09496-1

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