使用钆塞酸二钠增强磁共振成像（MRI）进行功能性残肝体积测量可预测超过一个肝段切除术后肝衰竭。
Functional remnant liver volumetry using Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) predicts post-hepatectomy liver failure in resection of more than one segment.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan.
Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan.
出版信息
HPB (Oxford). 2020 Feb;22(2):318-327. doi: 10.1016/j.hpb.2019.08.002. Epub 2019 Aug 30.
BACKGROUND
Gd-EOB-DTPA-enhanced magnetic resonance imaging (EOB-MRI) can be used for evaluating liver functional reserve. We assessed whether functional remnant liver volumetry (FRLV) using EOB-MRI predicted post-hepatectomy liver failure (PHLF) in resection of more than one segment.
METHODS
We retrospectively analyzed 155 cases of hepatectomy of more than one segment. For assessment of FRLV, signal intensity (SI) of remnant liver was measured in T1-weighted images. Functional remnant liver score was derived by division of SI of liver by SI of muscle (or spleen), resulting in liver-to-muscle ratio (LMR) and liver-to-spleen ratio (LSR). FRLV were calculated by multiplying LMR (or LSR) and remnant liver volume. We investigated preoperative factors predicting PHLF (≥grade B) in study cohort (all cases except for portal vein embolization [PVE], n = 129) and validation cohort (PVE cases, n = 26).
RESULTS
In study cohort, PHLF occurred in 5 patients (3.9%). In multivariate analysis, FRLV (LMR) was the most reliable predictor of PHLF (P = 0.013). The cutoff value of FRLV (LMR) predicting PHLF was 615 mL/m (AUC: 0.939). In validation cohort (n = 26), the cutoff value of FRLV (LMR) indicated reliable results, sensitivity (100%), specificity (77.3%), and accuracy (80.8%).
CONCLUSIONS
FRLV using LMR could precisely predict PHLF of more than one segment, and was useful even in patients who underwent PVE.
背景
钆塞酸二钠增强磁共振成像（EOB-MRI）可用于评估肝储备功能。我们评估了 EOB-MRI 测量的功能性残肝体积（FRLV）是否能预测超过一个肝段切除术后的肝衰竭（PHLF）。
方法
我们回顾性分析了 155 例超过一个肝段的肝切除术。为了评估 FRLV，我们在 T1 加权图像上测量残余肝的信号强度（SI）。功能性残肝评分是通过将肝的 SI 除以肌肉（或脾脏）的 SI 得出的，得到肝与肌肉的比值（LMR）和肝与脾脏的比值（LSR）。FRLV 通过将 LMR（或 LSR）与残余肝体积相乘计算得出。我们研究了研究队列（所有病例除门静脉栓塞术[PVE]外，n=129）和验证队列（PVE 病例，n=26）中预测 PHLF（≥B 级）的术前因素。
结果
在研究队列中，有 5 例（3.9%）发生 PHLF。多变量分析显示，FRLV（LMR）是预测 PHLF 的最可靠指标（P=0.013）。预测 PHLF 的 FRLV（LMR）截断值为 615mL/m（AUC：0.939）。在验证队列（n=26）中，FRLV（LMR）的截断值也得到了可靠的结果，灵敏度为 100%，特异性为 77.3%，准确性为 80.8%。
结论
使用 LMR 的 FRLV 可以准确预测超过一个肝段的 PHLF，即使在接受 PVE 的患者中也很有用。
Zotero 插件