A new formula to calculate the resection limit in hepatectomy based on Gd-EOB-DTPA-enhanced magnetic resonance imaging
A new formula to calculate the resection limit in hepatectomy based on Gd-EOB-DTPA-enhanced magnetic resonance imaging
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DOI：
10.1371/journal.pone.0210579
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发表时间：
2019-01-25
期刊：
影响因子：
3.7
通讯作者：
Yoshimoto, Toshiaki
中科院分区：
文献类型：
--
作者：
Yamada, Shinichiro;Shimada, Mitsuo;Yoshimoto, Toshiaki
背景与目的Gd-乙氧基苄基-二乙三胺五乙酸(EOB-MRI)动态磁共振成像不仅可用于肝脏肿瘤的诊断，还可用于评估肝功能。本研究的目的是建立一个新的基于EOB-MRI的公式来确定肝切除患者的切除范围。方法28例正常肝脏(NL组)和5例不能切除的肝硬变患者(UL组)接受了EOB-MRI检查。根据信号强度(SI)、各亚段体积(S1-S8)和体表面积计算标准化肝功能(SLF)。根据NL组和UL组患者SLF值的差异，设计了一个确定切除限度的公式。结果NL组和UL组的平均SLF值分别为2038和962Fv/m(2)。这一差异(1076Fv/m(2))与切除体积的70%一致。因此，肝切除的切除限度按70%：70x(SLF-962)/1076(%)的比例计算。1例超过切除范围行肝切除术的患者死于肝功能衰竭。49例手术切除量小于手术切除量的患者均安全完成手术。结论基于EOB-MRI的手术切除量计算公式可提高肝切除的安全性。
Background and aimDynamic magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) can be used not only to detect liver tumors but also to estimate liver function. The aim of this study was to establish a new EOB-MRI-based formula to determine the resection limit in patients undergoing hepatectomy.MethodsTwenty-eight patients with a normal liver (NL group) and five with an unresectable cirrhotic liver (UL group) who underwent EOB-MRI were included. Standardized liver function (SLF) was calculated based on the signal intensity (SI), the volume of each subsegment (S1-S8), and body surface area. A formula defining the resection limit was devised based on the difference in the SLF values of patients in the NL and UL groups. The formula was validated in 50 patients who underwent EOB-MRI and hepatectomy.ResultsThe average SLF value in the NL and UL groups was 2038 and 962 FV/m(2), respectively. The difference (1076 FV/m(2)) was consistent with a 70% in resection volume. Thus, the resection limit for hepatectomy was calculated as a proportion of 70%: 70x(SLF-962)/1076 (%). The one patient who underwent hepatectomy over the resection limit died due to liver failure. In other 49 patients, in whom the resection volume was less than the resection limit, procedures were safely performed.ConclusionsOur formula for resection limit based on EOB-MRI can improve the safety of hepatectomy.