Reducing the risk of post-hepatectomy liver failure using a novel MRI method to predict post-operative function.

肝癌通常是一种致命的疾病，只能通过一种名为肝切除术的外科手术来治愈，即切除含有癌症的肝脏部分。为了确定这种手术是否可能，通过磁共振成像(MRI)扫描仪获得的图像被用来计算手术后健康肝组织的数量。挑战是切除所有的癌症组织，但留下足够的肝脏来维持患者的生命。如果剩余的肝脏被认为太小，那么可以应用一种名为门静脉栓塞术的程序，这将使剩余的肝脏在真正进行手术之前迅速增长。一旦长得足够长，就可以安全地进行肝切除术。尽管进行了这样的手术，但大约十分之一的患者在手术后肝脏太小。这些患者将遭受术后肝功能衰竭的困扰，这种情况与严重的并发症有关，可能是致命的。我们认为，这一问题的部分原因是目前对术后肝功能的估计有时不准确。这些方法假设肝脏的所有部分都工作得一样好，但对于患有肝病的患者来说，情况并非如此，在这些患者中，某些部分可能受到损伤，活动不足，而另一些部分则过度活动。其影响可能是显著的：如果高估了剩余的肝功能，那么手术后可能没有足够的功能肝组织保留，可能会导致肝功能衰竭。或者，如果其余肝脏的功能被低估，那么患者可能会因为担心发生术后肝功能衰竭而被拒绝接受潜在的挽救生命的手术。我们团队最近开发了一种更准确的方法，使用标准的MRI扫描仪，使用快速成像和高级数据分析来测量剩余肝脏的功能。该方法可以添加到患者的常规MRI扫描中，因此患者没有额外的负担或额外的扫描。未来剩余肝脏的功能可以使用我们小组开发的专用软件工具从这些数据中计算出来。然后，这可以用来决定患者是否可以接受手术，以及是否需要门静脉栓塞术。这项研究的目的是证明这种新的成像技术可以对治疗决定以及最终的患者结果产生重大影响。我们将使用我们的新技术对考虑进行手术的患者进行成像，并将其与当前的体积测量方法进行比较。这些患者将在手术后接受随访，以确定那些出现肝功能衰竭的患者是否确实是那些高估了剩余肝脏功能的患者。如果我们的新技术被用于手术计划，我们还将评估未来如何改善治疗决策。我们将计算出有多少患者可以从我们的新技术中受益，以及未来如何确切地使用这一技术来改善患者的预后。如果这项研究证实了我们的新方法可以预测术后肝功能衰竭的风险，那么这可能会导致未来患者预后的改善。在这种情况下，下一步将是利用这些新信息提出改进的手术计划，并在临床试验中进行测试。最终，这可能会导致肝切除成功率的显着增加，以及将通过这种潜在的挽救生命的手术提供治疗的患者数量的显着增加。

Liver cancer is often a fatal disease, and can only be cured via a surgical procedure called "hepatectomy", where the part of the liver containing the cancer is removed. In order to decide whether this surgery is possible, pictures obtained by a magnetic resonance imaging (MRI) scanner are used to work out the amount of healthy liver tissue that will remain after surgery. The challenge is to remove all of the cancerous tissue, but leave enough liver behind to keep the patient alive. If the remaining liver is thought to be too small then a procedure called "portal vein embolisation" can be applied, which will cause the remaining liver to grow rapidly before the surgery is actually performed. As soon as it has grown enough, the hepatectomy can be performed safely. Despite procedures like this, about 1 in 10 patients are left after surgery with a liver that is too small. Those patients will suffer from post-operative liver failure, a condition that is associated with severe complications and can be fatal.We believe that this problem is partly caused by the fact that current estimates of post-operative liver function are sometimes inaccurate. These methods assume that all parts of the liver work equally well, but this is not the case in patients with liver disease where certain parts may be injured and underactive, and others overactive. The effect can be significant: if the remaining liver function is overestimated then it is possible that not enough functioning liver tissue remains after surgery and liver failure may result. Alternatively, if the remaining liver's function is underestimated then the patient may be denied potentially life-saving surgery out of fear for developing postoperative liver failure. Our group has recently developed a more accurate method to measure the remaining liver's function using standard MRI scanners, using fast imaging and advanced data analysis. The method can be added in patient's routine MRI scans, so there is no additional burden or extra scans for the patient. The function of the future remaining liver can be calculated from this data using a dedicated software tool developed in our group. This can then be used to decide whether the patient can undergo surgery, and whether portal vein embolisation is needed.The objective of this study is to prove that this new imaging technique can have a significant impact on treatment decisions and eventually also patient outcome. We will do this by imaging patients that are considered for surgery with our new technique, and comparing this against the current method of volume measurement. These patients will be followed up after surgery to see if those that develop liver failure are exactly those where the remaining liver's function was overestimated. We will also assess how treatment decision can be improved in the future if our new technique is used for surgery planning. We will work out how many patients can benefit from our new technique, and how exactly this could be used in the future to improve the patient's outcome. If this study confirms that our new method predicts the risk of post-operative liver failure, then this could lead to an improvement in patient outcomes in the future. In that case the next step would be to propose improved surgery planning using this new information, and test these in clinical trials. Eventually this may lead to a significant increase in the success rate of hepatectomy and in the number of patients that will be offered treatment with this potentially life-saving operation.