Liver failure after major liver resection: risk assessment by using preoperative Gadoxetic acid-enhanced 3-T MR
Andreas Wibmer1, Alexander M Prusa, Richard Nolz
1From the Departments of Radiology (A.W., R.N., A.B.S.) and Surgery (A.M.P., T.G., M.S.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Purpose:
To determine if gadoxetic acid-enhanced magnetic resonance (MR) imaging with measurement of relative liver enhancement (RLE) on hepatobiliary phase images can allow preoperative assessment of the risk of liver failure after major liver resection.
Materials And Methods:
The local institutional review committee approved this retrospective analysis and waived written informed consent. The study included 73 patients (39 men; median age, 64.4 years) who underwent gadoxetic acid-enhanced 3-T MR imaging before resection of three or more liver segments. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid. RLE was assessed in each liver segment and the mean value of all segments was used for analysis. Posthepatectomy liver failure was defined according to the "50-50 criteria" (ie, prothrombin time <50% and serum bilirubin >50 µmol/L on postoperative day 5) and the International Study Group of Liver Surgery (ISGLS) classification. The association of RLE and liver failure was tested with univariate and multivariate logistic regression analysis. In addition to RLE, the latter also included demographic, clinical, operative, and histologic variables.
Results:
Patients with liver failure according to the 50-50 criteria (n = 3) had significantly lower RLE (54.5%) than those without (125.6%) (P = .009). According to ISGLS criteria, RLE was 112.5% in patients with grade A liver failure (n = 20), 88.4% in patients with grade B (n = 7), 41.7% (n = 2) in patients with grade C, and 136.5% (P < .001) in those without liver failure. In a logistic regression analysis, RLE was inversely related to the probability of liver failure according to the 50-50 (P = .02) and ISGLS (P < .001) criteria. In a multivariate analysis, RLE was independently associated with a higher probability of liver failure according to ISGLS classification (P = .003).
Conclusion:
Gadoxetic acid-enhanced MR imaging can help with the assessment of the risk for liver failure after major liver resection.
Insights
Gadoxetic acid-enhanced MRI can predict liver failure risk after major liver resection. Lower relative liver enhancement (RLE) on hepatobiliary phase images indicates a higher risk of post-operative liver failure.
Area of Science:
- Radiology
- Hepatobiliary Imaging
- Surgical Oncology
Background:
- Major liver resection is a complex procedure with a significant risk of post-operative liver failure.
- Accurate preoperative risk assessment is crucial for patient management and surgical planning.
Purpose of the Study:
- To evaluate the utility of gadoxetic acid-enhanced magnetic resonance (MR) imaging in assessing the risk of liver failure after major liver resection.
- To determine if relative liver enhancement (RLE) on hepatobiliary phase MR images can predict posthepatectomy liver failure.
Main Methods:
- This retrospective study analyzed data from 73 patients undergoing major liver resection (≥3 segments) with preoperative gadoxetic acid-enhanced 3-T MR imaging.
- Relative liver enhancement (RLE) was calculated from hepatobiliary phase images. Posthepatectomy liver failure was assessed using the 50-50 criteria and the International Study Group of Liver Surgery (ISGLS) classification.
- Univariate and multivariate logistic regression analyses were performed to determine the association between RLE and liver failure.
Main Results:
- Patients who developed liver failure had significantly lower RLE values compared to those without.
- RLE was inversely associated with the probability of liver failure according to both the 50-50 and ISGLS criteria.
- In multivariate analysis, RLE was an independent predictor of higher probability of liver failure based on ISGLS classification.
Conclusions:
- Gadoxetic acid-enhanced MR imaging, specifically RLE measurement, is a valuable tool for preoperative risk stratification of liver failure after major liver resection.
- This imaging technique can aid clinicians in identifying patients at higher risk, potentially guiding surgical decisions and postoperative management.
