1 Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
2 Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2018 Sep;211(3):580-587. doi: 10.2214/AJR.17.19206. Epub 2018 Jul 11.
The objective of our study was to identify whether quantitative measurements from gadoxetic acid-enhanced MRI are useful for predicting posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) compared with and in combination with future remnant liver volume (FRLV) and an indocyanine green (ICG) clearance test.
Preoperative gadoxetic acid-enhanced MR images were retrospectively evaluated in 73 patients who underwent anatomic liver resection for HCC between 2011 and 2013. For quantitative measurement of hepatocyte function, relative liver enhancement (RLE) and remnant hepatocyte uptake index (rHUI) were measured using hepatobiliary phase MR images. FRLV was determined using measurements from preoperative CT scans. Univariate and multivariate analyses of measurements from gadoxetic acid-enhanced MRI, ICG clearance tests, and FRLV for finding predictors of PHLF were performed. To compare the diagnostic performance of predictors, ROC analyses were also performed.
Eighteen (25%) of 73 patients met the criteria for PHLF. Univariate analysis revealed that all measurements related to MRI including RLE, rHUI, ICG clearance, and FRLV were significantly associated with PHLF. Multivariate analysis showed that RLE, FRLV, ICG-plasma disappearance rate (ICG-PDR), rHUI, and rHUI corrected for body weight (rHUI-BW) were independent predictors of PHLF (p = 0.011, p = 0.034, p = 0.003, p < 0.001, and p = 0.001, respectively). In ROC analyses, AUCs of rHUI and rHUI-BW were larger than those of other independent predictors; the differences were statistically significant (for rHUI-BW vs RLE, ICG-PDR, and FRLV, p = 0.016, 0.007, and 0.046, respectively; for rHUI vs RLE and ICG-PDR, p = 0.045 and 0.016, respectively).
Measurements from gadoxetic acid-enhanced MRI predicted PHLF better than the ICG clearance test in patients with HCC who underwent hepatectomy.
我们的研究目的是确定与未来残肝体积（FRLV）和吲哚菁绿（ICG）清除试验相比，钆塞酸增强 MRI 的定量测量值是否可用于预测肝细胞癌（HCC）患者肝切除术后肝衰竭（PHLF），以及是否可与 FRLV 和 ICG 清除试验联合用于预测 PHLF。
回顾性分析了 2011 年至 2013 年间接受解剖性肝切除术治疗 HCC 的 73 例患者的术前钆塞酸增强 MRI 图像。使用肝胆期 MRI 图像测量相对肝增强（RLE）和残留肝细胞摄取指数（rHUI）来定量测量肝细胞功能。使用术前 CT 扫描测量 FRLV。对来自钆塞酸增强 MRI、ICG 清除试验和 FRLV 的测量值进行单变量和多变量分析，以寻找预测 PHLF 的指标。为了比较预测指标的诊断性能，还进行了 ROC 分析。
73 例患者中有 18 例（25%）符合 PHLF 标准。单变量分析显示，包括 RLE、rHUI、ICG 清除率和 FRLV 在内的所有与 MRI 相关的测量值均与 PHLF 显著相关。多变量分析显示，RLE、FRLV、ICG-血浆清除率（ICG-PDR）、rHUI 和体重校正的 rHUI（rHUI-BW）是 PHLF 的独立预测指标（p = 0.011、p = 0.034、p = 0.003、p <0.001 和 p = 0.001）。在 ROC 分析中，rHUI 和 rHUI-BW 的 AUC 大于其他独立预测指标；差异具有统计学意义（rHUI-BW 与 RLE、ICG-PDR 和 FRLV 相比，p = 0.016、0.007 和 0.046；rHUI 与 RLE 和 ICG-PDR 相比，p = 0.045 和 0.016）。
在接受肝切除术的 HCC 患者中，与 ICG 清除试验相比，钆塞酸增强 MRI 的测量值能更好地预测 PHLF。
