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，只能通过一种称为“肝切除术”的外科手术来治愈，即切除肝脏中含有癌细胞的部分。为了确定手术是否可行，使用磁共振成像（MRI）扫描仪获得的图像来计算手术后将保留的健康肝组织的数量。挑战在于切除所有的癌组织，但留下足够的肝脏来维持病人的生命。如果认为剩余的肝脏太小，那么可以采用一种称为“门静脉栓塞”的程序，这将导致剩余的肝脏在手术前迅速生长。只要它长得足够大，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留下的肝脏太小。这些患者将遭受术后肝功能衰竭，这种情况与严重的并发症有关，可能是致命的。我们认为这个问题部分是由于目前对术后肝功能的估计有时是不准确的。这些方法假设肝脏的所有部分都同样工作良好，但对于患有肝病的患者来说，情况并非如此，因为某些部分可能受伤且活动不足，而其他部分则过度活跃。影响可能是显著的：如果剩余的肝功能被高估，那么手术后可能没有足够的功能肝组织，可能导致肝功能衰竭。或者，如果剩余的肝脏功能被低估，那么由于担心术后肝功能衰竭，患者可能会被拒绝进行可能挽救生命的手术。我们的团队最近开发了一种更准确的方法来测量剩余的肝脏功能，使用标准的MRI扫描仪，使用快速成像和先进的数据分析。该方法可以添加到患者的常规MRI扫描中，因此不会给患者带来额外的负担或额外的扫描。使用我们小组开发的专用软件工具，可以根据这些数据计算未来剩余肝脏的功能。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。这项研究的目的是证明这种新的成像技术可以对治疗决策产生重大影响，并最终对患者的预后产生影响。我们将通过对考虑用我们的新技术进行手术的患者进行成像，并将其与目前的体积测量方法进行比较来做到这一点。这些患者将在手术后进行随访，看看那些出现肝功能衰竭的患者是否正是那些剩余肝脏功能被高估的患者。我们还将评估如果我们的新技术用于手术计划，将来如何改进治疗决策。我们将计算出有多少患者可以从我们的新技术中受益，以及未来如何准确地使用这项技术来改善患者的预后。如果这项研究证实我们的新方法可以预测术后肝衰竭的风险，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，这可能会显著提高肝切除术的成功率，并增加接受这种可能挽救生命的手术治疗的患者数量。

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.