Lin Huimin, Wang Yihuan, Zhou Jiahao, Yang Yuchen, Xu Xinxin, Ma Di, Chen Yongjun, Yang Chunxue, Sack Ingolf, Guo Jing, Li Ruokun, Yan Fuhua
Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights Imaging. 2022 Jun 3;13(1):95. doi: 10.1186/s13244-022-01232-5.
Estimating liver function reserve is essential for preoperative surgical planning and predicting post-hepatectomy complications in patients with hepatocellular carcinoma (HCC). We investigated hepatic viscoelasticity quantified by tomoelastography, a multifrequency magnetic resonance elastography technique, to predict liver function reserve.
One hundred fifty-six patients with suspected HCC (mean age, 60 ± 1 years; 131 men) underwent preoperative tomoelastography examination between July 2020 and August 2021. Sixty-nine were included in the final analysis, and their 15-min indocyanine green retention rates (ICG-R15s) were obtained to determine liver function reserve. Tomoelastography quantified the shear wave speed (c, m/s), which represents stiffness, and loss angle (φ, rad), which represents fluidity. Both were correlated with the ICG-R15. A prediction model based on logistic regression for major hepatectomy tolerance (ICG-R15 ≥ 14%) was established.
Patients were assigned to either the ICG-R15 < 14% (n = 50) or ICG-R15 ≥ 14% (n = 19) group. Liver c (r = 0.617) and φ (r = 0.517) were positively correlated with the ICG-R15 (both p < 0.001). At fibrosis stages F1-2, φ was positively correlated with the ICG-R15 (r = 0.528; p = 0.017), but c was not (p = 0.104). At stages F3-4, c (r = 0.642; p < 0.001) and φ (r = 0.377; p = 0.008) were both positively correlated with the ICG-R15. The optimal cutoffs of c and φ for predicting ICG-R15 ≥ 14% were 2.04 m/s and 0.79 rad, respectively. The area under the receiver operating characteristic curve was higher for c (0.892) than for φ (0.779; p = 0.045).
Liver stiffness and fluidity, quantified by tomoelastography, were correlated with liver function and may be used clinically to noninvasively assess liver function reserve and stratify treatments.
评估肝功能储备对于肝细胞癌（HCC）患者的术前手术规划和预测肝切除术后并发症至关重要。我们研究了通过多频磁共振弹性成像技术——断层弹性成像量化的肝脏粘弹性，以预测肝功能储备。
2020年7月至2021年8月期间，156例疑似HCC患者（平均年龄60±1岁；131例男性）接受了术前断层弹性成像检查。最终分析纳入69例患者，并获取他们的15分钟靛氰绿滞留率（ICG-R15）以确定肝功能储备。断层弹性成像量化了代表硬度的剪切波速度（c，米/秒）和代表流动性的损耗角（φ，弧度）。两者均与ICG-R15相关。建立了基于逻辑回归的预测模型，用于预测大肝切除耐受性（ICG-R15≥14%）。
患者被分为ICG-R15＜14%（n = 50）组或ICG-R15≥14%（n = 19）组。肝脏的c（r = 0.617）和φ（r = 0.517）与ICG-R15呈正相关（均p＜0.001）。在纤维化F1-2期，φ与ICG-R15呈正相关（r = 0.528；p = 0.017），但c无相关性（p = 0.104）。在F3-4期，c（r = 0.642；p＜0.001）和φ（r = 0.377；p = 0.008）均与ICG-R15呈正相关。预测ICG-R15≥14%时，c和φ的最佳截断值分别为2.04米/秒和0.79弧度。c的受试者工作特征曲线下面积（0.892）高于φ（0.779；p = 0.045）。
通过断层弹性成像量化的肝脏硬度和流动性与肝功能相关，可在临床上用于无创评估肝功能储备和分层治疗。
