Gd-EOB-DTPA-enhanced MRI for monitoring future liver remnant function after portal vein embolization and extended hemihepatectomy: A prospective trial
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To evaluate changes in liver function after right portal vein embolization (PVE) and extended right hemihepatectomy using gadolinium ethoxybenzyl-DTPA-enhanced (Gd-EOB-DTPA) MRI.
In this prospective trial, 37 patients undergoing PVE were examined before and 14 and 28 days after PVE and 10 days after extended hemihepatectomy using Gd-EOB-DTPA-enhanced MRI. Lobar volume, kinetic growth rate (KGR), relative enhancement (RE) as well as hepatocellular uptake index (HUI) and fat signal fraction (FSF) were calculated for each lobe.
RE of the left liver lobe (LLL) was steadily increasing after PVE and decreased to 0.48 ± 0.19 10 days after surgery, which is significantly lower than 14 days and 28 days post PVE (P < 0.05). KGR was 14.06 ± 9.82%/week for the period from PVE to 14 days after PVE. HUI of the LLL increased steadily after PVE and was significantly higher at both 14 and 28 days after PVE compared to pre PVE (P < 0.05). HUI of the residual liver after surgery was lower than before.
Gd-EOB-DTPA-enhanced MRI may be used to monitor the functional increase in the FLR after PVE and to depict the intraoperative liver injury leading to a decrease in liver remnant function.
• The most significant FLR volume increase happens within the first 14 days.
• No MRI parameter was able to predict the success of FLR growth.
• Our data suggest an early resection about 14 days after PVE.
• Routine Gd-EOB-DTPA-enhanced MRI might be suitable to replace ICG-test.
KeywordsLiver Portal vein embolization Gadolinium ethoxybenzyl DTPA Liver function tests Magnetic resonance imaging
Abbreviations and acronyms
Fat signal fraction
Future liver remnant
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid
Hepatic uptake index
Kinetic growth rate
Maximum liver function capacity
Left liver lobe
Portal vein embolisation
Right liver lobe
Region of interest
Volume interpolated breath-hold examination
The scientific guarantor of this publication is Dominik Geisel. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in European Radiology. Methodology: prospective, observational/experimental, performed at one institution
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