Department of Radiology, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan.
Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
Abdom Radiol (NY). 2021 Jul;46(7):3193-3204. doi: 10.1007/s00261-021-02991-3. Epub 2021 Mar 8.
To retrospectively compare the predictive value of computed tomography volumetry (CTV), magnetic resonance elastography (MRE) of the liver, and their combination for major complications after liver resection.
We enrolled 108 consecutive patients who underwent anatomical liver resection for liver tumors and preoperative contrast-enhanced CT and MRE. The future liver remnant (FLR) ratio was calculated by CTV, while the liver stiffness measurement (LSM) was obtained by MRE. FLR ratio alone, LSM alone, and combined FLR ratio and LSM were evaluated to predict major complications (Clavien-Dindo grade ≥ IIIa). Univariate and multivariate analyses of hepatic biochemical parameters and imaging data were performed to identify predictors of major complications. Receiver operating characteristic analyses of FLR ratio, LSM, and their combination were performed, and the sensitivity and specificity were calculated.
Twenty-two (20.4%) of the 108 patients experienced major complications. According to multiple regression analysis, the FLR ratio (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.91-0.99, p = 0.040) and LSM (OR 1.72, 95% CI 1.01-2.94, p = 0.047) were independent predictors of major complications. The combined FLR ratio and LSM were predictive of major complications, with an area under the curve (AUC) of 0.818, sensitivity of 68.2%, and specificity of 84.9%. The AUC and specificity for combined FLR ratio and LSM were larger than those for FLR ratio (AUC: 0.711, specificity: 80.2%) and LSM (AUC: 0.793, specificity: 80.2%).
Combined CTV and MRE analysis can improve the AUC and specificity for predicting major complications after anatomical liver resection.
回顾性比较计算机断层扫描体积测量（CTV）、肝脏磁共振弹性成像（MRE）及其联合应用对肝切除术后主要并发症的预测价值。
我们纳入了 108 例连续接受解剖性肝切除术治疗肝肿瘤的患者，并进行了术前增强 CT 和 MRE 检查。通过 CTV 计算未来肝体积（FLR）比值，通过 MRE 获得肝脏硬度测量值（LSM）。评估单独的 FLR 比值、LSM 和联合的 FLR 比值和 LSM，以预测主要并发症（Clavien-Dindo 分级≥IIIa）。对肝生化参数和影像学数据进行单因素和多因素分析，以确定主要并发症的预测因素。对 FLR 比值、LSM 及其联合应用进行受试者工作特征曲线分析，并计算其敏感性和特异性。
108 例患者中有 22 例（20.4%）发生了主要并发症。根据多因素回归分析，FLR 比值（比值比 [OR] 0.96，95%置信区间 [CI] 0.91-0.99，p=0.040）和 LSM（OR 1.72，95%CI 1.01-2.94，p=0.047）是主要并发症的独立预测因素。联合 FLR 比值和 LSM 可预测主要并发症，曲线下面积（AUC）为 0.818，敏感性为 68.2%，特异性为 84.9%。联合 FLR 比值和 LSM 的 AUC 和特异性均大于 FLR 比值（AUC：0.711，特异性：80.2%）和 LSM（AUC：0.793，特异性：80.2%）。
联合 CTV 和 MRE 分析可提高解剖性肝切除术后预测主要并发症的 AUC 和特异性。
