Simeth Josiah, Aryal Madhava, Owen Dawn, Cuneo Kyle, Lawrence Theodore S, Cao Yue
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
Biomedical Engineering, University of Michigan, Ann Arbor, MI.
Adv Radiat Oncol. 2022 Mar 16;7(5):100942. doi: 10.1016/j.adro.2022.100942. eCollection 2022 Sep-Oct.
Global and regional liver function assessments are important for defining the magnitude and spatial distribution of dose to preserve functional liver parenchyma and reduce incidence of hepatotoxicity from radiation therapy for intrahepatic cancer treatment. This individualized liver function-guided radiation therapy strategy is critical for patients with heterogeneous and poor liver function, often observed in cirrhotic patients treated for hepatocellular carcinoma. This study aimed to validate as a measure of global and regional function through comparison with 2 well-regarded global function measures: indocyanine green retention (ICGR) and albumin-bilirubin (ALBI).
Seventy-nine dynamic gadoxetic acid enhanced magnetic resonance imaging scans were acquired in 40 patients with hepatocellular carcinoma in institutional review board approved prospective protocols. Portal venous perfusion ( ) was quantified from gadoxetic acid enhanced magnetic resonance imaging using a dual-input 2-compartment model, and gadoxetic acid uptake rate ( was fitted using a linearized single-input 2-compartment model chosen for robust estimation. Four image-derived measures of global liver function were tested: (1) mean multiplied by liver volume ( ) (functional volume), (2) mean multiplied by blood distribution volume ( ) (3) mean and (4) liver volume ( ). The measure's correlation with corresponding ICGR and ALBI tests was assessed using linear regression. Voxel-wise similarity between and was compared using Spearman ranked correlation.
Significant correlations ( < .05) with ICGR and ALBI were found for and (in order of strength), but not for mean The mean ranked correlation coefficient between and maps was 0.09. and maps were predominantly mismatched in patients with poor liver function.
The metric combining function and liver volume ( ) was a stronger measure of global liver function compared with perfusion or liver volume alone, especially in patients with poor liver function. Gadoxetic acid uptake rate is promising for both global and regional liver function.
全球和区域肝功能评估对于确定剂量的大小和空间分布至关重要，以保护功能性肝实质并降低肝内癌症放射治疗引起肝毒性的发生率。这种个体化的肝功能引导放射治疗策略对于肝功能异质性和较差的患者至关重要，这在接受肝细胞癌治疗的肝硬化患者中经常可见。本研究旨在通过与两种备受认可的全球功能指标：吲哚菁绿滞留率（ICGR）和白蛋白-胆红素（ALBI）进行比较，验证作为全球和区域功能指标的有效性。
在机构审查委员会批准的前瞻性方案中，对40例肝细胞癌患者进行了79次动态钆塞酸增强磁共振成像扫描。使用双输入双室模型从钆塞酸增强磁共振成像中量化门静脉灌注（ ），并使用为稳健估计而选择的线性化单输入双室模型拟合钆塞酸摄取率（ ）。测试了四种基于图像的全球肝功能指标：（1）平均 乘以肝脏体积（ ）（功能体积），（2）平均 乘以血液分布体积（ ），（3）平均 ，以及（4）肝脏体积（ ）。使用线性回归评估该指标与相应的ICGR和ALBI测试的相关性。使用Spearman等级相关性比较 和 之间的体素级相似性。
对于 和 （按强度顺序），发现与ICGR和ALBI存在显著相关性（ <.05），但对于平均 则未发现。 和 图谱之间的平均等级相关系数为0.09。在肝功能较差的患者中， 和 图谱主要不匹配。
与单独的灌注或肝脏体积相比，结合功能和肝脏体积（ ）的指标是一种更强的全球肝功能指标，尤其是在肝功能较差的患者中。钆塞酸摄取率对于全球和区域肝功能都很有前景。
