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Efficiency of regional functional liver volume assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein tumor thrombus

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Abstract

Purpose

We investigated whether functional future remnant liver volume (fFRLV), assessed using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), could evaluate regional liver function in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and help establish the indication for hepatectomy.

Methods

The subjects of this study were 12 patients with PVTT [PVTT(+) group] and 58 patients without PVTT [PVTT(−) group], from among 191 patients who underwent hepatectomy of more than one segment for HCC. We calculated the liver-to-muscle ratio (LMR) in the remnant liver, using EOB-MRI and fFRLV. Preoperative factors and surgical outcome were compared between the groups. The LMR of the area occluded by PVTT was compared with that of the non-occluded area.

Results

The indocyanine green retention rate at 15 min (ICG-R15) and liver fibrosis indices were increased in the PVTT(+) group, but the surgical outcomes of patients in this group were acceptable, with no liver failure, no mortality, and no differences from those in the PVTT(−) group. The fFRLV in the PVTT(+) group was not significantly different from that in the PVTT(−) group (p = 0.663). The LMR was significantly lower in the occluded area than in the non-occluded area (p = 0.004), indicating decreased liver function.

Conclusion

Assessing fFRLV using EOB-MRI could be useful for evaluating regional liver function and establishing operative indications for HCC with PVTT.

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Acknowledgments

We thank H. Tanaka, K. Hagiwara, K. Hoshino, and R. Muranushi for collecting data that formed the basis of this study. We also thank K. Ujita and J. Fukuda for their special assistance in image analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Kenichiro Araki, Norifumi Harimoto, Takahiro Yamanaka, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Norio Kubo & Ken Shirabe

  2. Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Gunma, Japan

    Yoshito Tsushima

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  1. Kenichiro Araki
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Correspondence to Norifumi Harimoto.

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Supplemental Fig.

 1. Correlation scatter plots between functional future remnant liver volume (fFRLV) and ICG-Krem and between fFRLV and functional  %RLV of 3D-CT/SPECT fusion in the PVTT(+) group.(a) Correlation of fFRLV and ICG-Krem in the PVTT(+) group. (b) Correlation of fFRLV and functional  %RLV of 3D-CT/SPECT fusion in the PVTT(+) group

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Araki, K., Harimoto, N., Yamanaka, T. et al. Efficiency of regional functional liver volume assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein tumor thrombus. Surg Today 50, 1496–1506 (2020). https://doi.org/10.1007/s00595-020-02062-y

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