Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
Eur Radiol. 2021 Jul;31(7):4720-4730. doi: 10.1007/s00330-020-07606-x. Epub 2021 Jan 15.
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.
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 (T1) and functional liver volume (FV), whereas regional parameters included the rT1, rT1, remnant FV (rFV), and remnant FV ratio (rFV) 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.
The T1 and FV were correlated with the ICG test (rho = - 0.304 and - 0.449, p < 0.05). FV < 682.8 ml indicated preoperative ICG- ≥ 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 rT1 (< 66.5%) and high rT1 (> 217.5 ms) may predict major complications (AUC = 0.831 and 0.756, respectively; p < 0.05). The rT1 was an independent risk factor for postoperative major complications (odds ratio [OR] = 0.845, 95% CI, 0.736-0.966; p < 0.05).
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.
• 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.
探讨术前钆塞酸增强 MRI 结合计算机辅助虚拟肝切除术评估定量区域性肝功能对预测 HCC 患者行大肝切除术后短期结局的作用。
我们回顾性分析了 133 例连续 HCC 患者的术前钆塞酸增强 MRI 和吲哚菁绿（ICG）检查记录。45 例行开腹大肝切除术。通过计算机辅助虚拟肝切除术评估肝功能储备和剩余肝脏。全局肝脏功能参数包括 T1 弛豫时间减少率（T1）和功能性肝体积（FV），而区域性参数包括剩余肝脏的 rT1、rT1、剩余 FV（rFV）和剩余 FV 比（rFV）。MRI 和 ICG 的功能参数用于预测大肝切除术后的短期结局（肝功能衰竭和主要并发症）。
T1 和 FV 与 ICG 检查相关（rho=-0.304 和-0.449，p<0.05）。FV<682.8ml 表示术前 ICG-≥14%，曲线下面积（AUC）为 0.765。无患者因良好的肝功能储备（ICG<14%）和足够的剩余肝体积（>30%标准 LV）而行大切除术后出现肝功能衰竭。低 rT1（<66.5%）和高 rT1（>217.5ms）可能预测主要并发症（AUC=0.831 和 0.756，分别；p<0.05）。rT1 是术后发生主要并发症的独立危险因素（优势比[OR]，0.845；95%CI，0.736-0.966；p<0.05）。
术前钆塞酸增强 MRI 结合计算机辅助虚拟肝切除术可有助于对区域性肝储备功能进行最佳评估，以预测 HCC 患者行大肝切除术后的短期结局。
术前钆塞酸增强 MRI 结合虚拟肝切除术和容积分析可提供精确的肝体积和区域性功能评估。
钆塞酸增强 MRI 评估的定量区域性肝功能可预测 HCC 患者大肝切除术后的短期结局。
钆塞酸增强 MRI 评估的区域性肝功能是术后发生主要并发症的独立危险因素。
