Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion
Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion
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DOI：
10.1016/j.ejrad.2020.109189
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发表时间：
2020-09-01
影响因子：
3.3
通讯作者：
Murakami, Takamichi
中科院分区：
文献类型：
--
作者：
Tsujita, Yushi;Sofue, Keitaro;Murakami, Takamichi
目的：准确预测肝切除术后肝功能衰竭(PHLF)对晚期肝细胞癌(HCC)非常重要。我们的目的是回顾评价肝细胞癌合并门静脉受累的解剖肝切除术后，加多沙酸增强磁共振成像对预测门静脉高压症的价值。注射加多沙酸20分钟后，使用3D脂肪抑制T1加权破坏梯度回波序列采集肝胆相MR图像。计算肝脾比(LSR)、残存肝细胞摄取指数(RHUI)和回声系数。PHLF的严重程度是根据国际肝外科研究小组定义的。分别用Wilcoxon符号秩和检验和Wilcoxon秩和检验比较切除肝与残肝的LSR、NO/轻度PHLF与重度PHLF的HUI及rHUI/HUE的差异。采用单因素和多因素Logistic回归分析确定重度PHLF的预测因素。计算rHUI和rHUI/HU的受试者工作特征曲线(AUC)下面积预测重度PHLF。残肝的LSR显著高于切除肝(P<；0.001)。重度PHLF的rHUI(P<；0.001)和rHUI/HUE(P<；0.001)显著低于无/轻度PHLF。多因素Logistic回归分析显示，rHUI降低(P=0.012，AUC=0.885)和rHUI/HUE(P=0.002，AUC=0.852)是预测重度PHLF的独立因素。结论：Gadoxtic酸增强MRI是一种有希望的无创性检查，可在肝切除前评估肝功能残留量，准确预测重度PHLF。
Purpose: Accurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion.Methods: Forty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF.Results: Nine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF.Conclusion: Gadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.