Department of Hepatobiliary and Pancreatic Surgery, 26351National Cancer Center Hospital East, Kashiwa, Japan.
Clinical Research Support Office, 26351National Cancer Center Hospital East, Kashiwa, Japan.
Am Surg. 2022 Sep;88(9):2353-2360. doi: 10.1177/00031348211011095. Epub 2021 Apr 15.
The liver-to-spleen signal intensity ratio (LSR) on magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid has been used as a parameter to assess liver function. LSR of the future remnant liver region (FR-LSR) is included in preoperative assessment of regional liver function. The aim of this study was to investigate the predictability of post-hepatectomy liver failure (PHLF) by FR-LSR.
Between May 2013 and May 2019, 127 patients underwent standardized EOB-MRI for diagnosis of liver tumor before major hepatectomy. The FR-LSR on EOB-MRI was calculated by a semiautomated three-dimensional volumetric analysis system. The cutoff value of FR-LSR in association with clinically relevant PHLF was determined according to the areas under the receiver operating characteristic curves. Then, FR-LSR and clinical variables were analyzed to assess the risk of clinically relevant PHLF.
In patients with preoperative biliary drainage, metastatic liver tumor, estimated future remnant liver volume <50%, biliary reconstruction, operation time ≥ 480 min, estimated blood loss ≥ 1000 g, blood transfusion and a FR-LSR < 2.00 were associated with clinically relevant PHLF ( < .05 for all) in univariable analysis. The liver-to-spleen signal intensity ratio of the future remnant liver region < 2.00 was the only independent risk factor for clinically relevant PHLF in multivariable risk analysis (OR, 27.90; 95% CI: 7.99-136.40; < .05).
The present study revealed that FR-LSR calculated using a 3-dimensional volumetric analysis system was an independent risk factor for clinically relevant PHLF. The liver-to-spleen signal intensity ratio of the future remnant liver region might be a reliable preoperative parameter in liver functional assessment, enabling safe performance of major hepatectomy.
磁共振成像（MRI）钆塞酸二钠增强扫描后肝脾信号强度比（LSR）可用于评估肝功能，其中未来残留肝脏区域（FR-LSR）的 LSR 被纳入肝部分切除术的术前区域性肝功能评估。本研究旨在探讨 FR-LSR 对预测肝切除术后肝功能衰竭（PHLF）的价值。
2013 年 5 月至 2019 年 5 月，127 例行肝切除术的肝肿瘤患者术前行 EOB-MRI 检查。采用半自动三维容积分析系统计算 FR-LSR。根据受试者工作特征曲线下面积确定与临床相关 PHLF 相关的 FR-LSR 截断值。然后，分析 FR-LSR 和临床变量以评估临床相关 PHLF 的风险。
术前胆道引流、转移性肝肿瘤、预计未来残留肝脏体积＜50%、胆道重建、手术时间≥480min、估计出血量≥1000g、输血和 FR-LSR＜2.00 与临床相关 PHLF 相关（均<0.05）。多变量风险分析显示，FR-LSR＜2.00 是临床相关 PHLF 的唯一独立危险因素（OR 27.90，95%CI：7.99~136.40，<0.05）。
本研究显示，三维容积分析系统计算的 FR-LSR 是临床相关 PHLF 的独立危险因素。FR-LSR 可能是一种可靠的术前肝功能评估参数，有助于安全施行肝切除术。
