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Regional liver function analysis with gadoxetic acid–enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC

  • Gastrointestinal
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Abstract

Objectives

To explore the role of quantitative regional liver function assessed by preoperative gadoxetic acid–enhanced MRI with computer-aided virtual hepatectomy to predict short-term outcomes after major hepatectomy for HCC.

Methods

We retrospectively reviewed the records of 133 consecutive patients with HCC who underwent preoperative gadoxetic acid–enhanced MRI and indocyanine green (ICG) test. Forty-five patients received open major hepatectomy. Liver function reserve and the future liver remnant were evaluated by computer-aided virtual hepatectomy. Global liver functional parameters included the T1 relaxation time reduction rate (T1ratio) and functional liver volume (FV), whereas regional parameters included the rT1pos, rT1ratio, remnant FV (rFV), and remnant FV ratio (rFVratio) of the remnant liver. The functional parameters of the MRI and ICG were used to predict the short-term outcomes (liver failure and major complications) after major hepatectomy.

Results

The T1ratio and FV were correlated with the ICG test (rho = − 0.304 and − 0.449, p < 0.05). FV < 682.8 ml indicated preoperative ICG-R15 ≥ 14% with 0.765 value of the area under the curve (AUC). No patient who underwent major resection with good liver functional reserve (ICG < 14%) and enough future remnant volume (> 30% standard LV) developed liver failure. Low rT1ratio (< 66.5%) and high rT1pos (> 217.5 ms) may predict major complications (AUC = 0.831 and 0.756, respectively; p < 0.05). The rT1ratio was an independent risk factor for postoperative major complications (odds ratio [OR] = 0.845, 95% CI, 0.736–0.966; p < 0.05).

Conclusion

Preoperative gadoxetic acid–enhanced MRI with computer-aided virtual hepatectomy may facilitate optimal assessment of regional liver functional reserve to predict short-term outcomes after major hepatectomy for HCC.

Key Points

• Preoperative gadoxetic acid–enhanced MRI with virtual hepatectomy and volumetric analysis can provide precise liver volume and regional functional assessment.

• Quantitative regional liver function assessed by gadoxetic acid–enhanced MRI can predict the short-term outcomes after major hepatectomy in patients with HCC.

• The regional liver function assessed by gadoxetic acid–enhanced MRI is an independent risk factor for postoperative major complications.

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Abbreviations

AUC:

Area under the curve

FLR:

Future liver remnant

FV:

Functional liver volume

ICG:

Indocyanine green

LV:

Liver volume

MRI:

Magnetic resonance imaging

OR:

Odds ratio

PHLF:

Post-hepatectomy liver failure

rFV:

Remnant functional liver volume

rFVratio :

Remnant functional volume ratio

ROC:

Receiver operating characteristic

T1ratio :

Reduction rate of T1 relaxation time

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Acknowledgements

We greatly appreciate the understanding and support of the enrolled patients, and the support by the National Natural Science Foundation of China (No. 81971684, 81771908, 81571750, 81770654).

Funding

This study has received funding by National Natural Science Foundation of China (No. 81971684, 81771908, 81571750, 81770654).

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Author notes

  1. Mengqi Huang Shunli Shen have equal contribution and are co-first authors

Authors and Affiliations

  1. Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China

    Mengqi Huang, Huasong Cai, Zhenpeng Peng, Zi-Ping Li & Shi-Ting Feng

  2. Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China

    Shunli Shen & Baogang Peng

  3. Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Wan Hang Keith Chiu

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  1. Mengqi Huang
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Correspondence to Baogang Peng or Shi-Ting Feng.

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The scientific guarantor of this publication is Shi-Ting Feng.

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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.

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Huang, M., Shen, S., Cai, H. et al. Regional liver function analysis with gadoxetic acid–enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC. Eur Radiol 31, 4720–4730 (2021). https://doi.org/10.1007/s00330-020-07606-x

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