Functional remnant liver assessment predicts liver‐related morbidity after hepatic resection in patients with hepatocellular carcinoma

Itoh, Shinji; Yoshizumi, Tomoharu; Shirabe, Ken; Kimura, Koichi; Okabe, Hidetoshi; Harimoto, Norifumi; Ikegami, Toru; Uchiyama, Hideaki; Nishie, Akihiro; Maehara, Yoshihiko

doi:10.1111/hepr.12761

Cited by 35 publications

(30 citation statements)

References 23 publications

(53 reference statements)

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“…Itoh et al assessed the functional liver remnant by MDCT volumetry—normalised to the body surface area—and the liver enhancement in gadoxetic acid enhanced MRI [ 12 ]. Compared to our study, instead of remnantRLE, the remnant function was calculated as the ratio of the liver to the psoas muscle on the hepatobiliary phase and on the pre-contrast phase.…”

Section: Discussionmentioning

confidence: 99%

Post-hepatectomy liver failure after major hepatic surgery: not only size matters

et al. 2018

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ObjectivesTo compare the value of functional future liver remnant (functFLR) to established clinical and imaging variables in prediction of post-hepatectomy liver failure (PHLF) after major liver resection.MethodsThis retrospective, cross-sectional study included 62 patients, who underwent gadoxetic acid enhanced MRI and MDCT within 10 weeks prior to resection of ≥ 4 liver segments. Future liver remnant (FLR) was measured in MDCT using semi-automatic software. Relative liver enhancement for each FLR segment was calculated as the ratio of signal intensity of parenchyma before and 20 min after i.v. administration of gadoxetic acid and given as mean (remnantRLE). Established variables included indocyanine green clearance, FLR, proportion of FLR, weight-adapted FLR and remnantRLE. functFLR was calculated as FLR multiplied by remnantRLE and divided by patient’s weight. The association of measured variables and PHLF was tested with univariate and multivariate logistic regression analysis and receiver operator characteristics (ROC) curves compared with the DeLong method.ResultsSixteen patients (25.8%) experienced PHLF. Univariate logistic regression identified FLR (p = 0.015), proportion of FLR (p = 0.004), weight-adapted FLR (p = 0.003), remnantRLE (p = 0.002) and functFLR (p = 0.002) to be significantly related to the probability of PHLF. In multivariate logistic regression analysis, a decreased functFLR was independently associated with the probability of PHLF (0.561; p = 0.002). Comparing ROC curves, functFLR showed a significantly higher area under the curve (0.904; p < 0.001) than established variables.ConclusionsfunctFLR seems to be superior to established variables in prediction of PHLF after major liver resection.Key Points • functFLR is a parameter combining volumetric and functional imaging information, derived from MDCT and gadoxetic acid enhanced MRI. • In comparison to other established methods, functFLR is superior in prediction of post-hepatectomy liver failure. • functFLR could help to improve patient selection prior major hepatic surgery.

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Section: Discussionmentioning

confidence: 99%

Post-hepatectomy liver failure after major hepatic surgery: not only size matters

et al. 2018

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“…There are also a number of other similar studies. However, they have had difficulty proving the usefulness of gadoxetate-enhanced MRI since the number of patients suffering liver failure is small, thus leaving most studies underpowered [137][138][139].…”

Section: Liver Surgerymentioning

confidence: 99%

Non-Invasive Characterization of Liver Disease : By Multimodal Quantitative Magnetic Resonance

Karlsson

2020

Linköping University Medical Dissertations

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There is a large and unmet need for diagnostic tool that can be used to characterize chronic liver diseases (CLD). In the earlier stages of CLD, much of the diagnostics involves performing biopsies, which are evaluated by a histopathologist for the presence of e.g. fat, iron, inflammation, and fibrosis. Performing biopsies, however, have two downsides: i) biopsies are invasive and carries a small but non-negligible risk for serious complications, ii) biopsies only represents a tiny portion of the liver and are thus prone to sampling error. Moreover, in the later stages of CLD, when the disease has progressed far enough, the ability of the liver to perform its basic function will be compromised. In this stage, there is a need for better methods for accurately measuring liver function. Additionally, measures of liver function can also be used when developing new drugs, as biomarkers for drug-induced liver injury (DILI), which is a serious drug-safety issue. Magnetic resonance imaging (MRI) is a non-invasive medical imaging modality, which have shown much promise with regards to characterizing liver disease in all of the above-mentioned aspects. The aim of this PhD project was to develop and validate MR-based methods that can be used to non-invasively characterize liver disease. Paper I investigated if R2* mapping, a MR-method for measuring liver iron content, can be confounded by liver fat. The results show fat does affect R2*. The conclusion was therefore that fat must be taken into account when measuring small amounts of liver iron, as a small increase in R2* could be due to either small amounts of iron or large amounts of fat. Paper II examined whether T1 mapping, which is another MR-method, can be used for staging liver fibrosis. The results of previous research have been mixed; some studies have been very promising, whereas other studies have been less promising. Unfortunately, the results in Paper II belongs to the less promising studies. Paper III focused on measuring liver function by dynamic contrast-enhanced MRI (DCE-MRI) using a liver specific contrast agent, which is taken up the hepatocytes and excreted to the bile. The purpose of the paper was to extend and validate a method for estimating uptake and efflux rates of the contrast agent. The method had previously only been applied in health volunteers. Paper II showed that the method can be applied to CLD patients and that the uptake of the contrast agent is lower in patients with advanced fibrosis.

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“…A combination of such established non-invasive approaches may provide a better prediction of remnant liver function. By contrast, novel assessments, such as 99mTc-galactosyl serum albumin scintigraphy combined with computed tomography volumetry [ 66 , 67 ] and three-dimensional reconstruction, and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI [ 68 ] are better quantitative measures of future liver functional volume and regeneration ability and can give a more accurate prediction of liver-related morbidity after hepatic resection in patients with HCC. These advanced preoperative assessments are convenient for surgeons to determine suitable candidates for resection and helpful to improve the safety of surgical resection.…”

Section: Multidisciplinary Diagnosis and Treatment To Improve The Effmentioning

confidence: 99%

Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms: a review and update

Wang

Bai

et al. 2017

Oncotarget

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Portal vein tumor thrombus (PVTT) usually worsens prognosis of hepatocellular carcinoma (HCC), as characterized by aggressive disease progression, impaired liver function and tolerance to treatment. Conventionally, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) accepted the Barcelona Clinical Liver Cancer (BCLC) treatment algorithms, identifying PVTT as an absolute contra-indication of surgical resection for HCC. HCC-PVTT patients are offered sorafenib as the standard treatment. Evidently, SHARP and Asia-Pacific trials demonstrated that sorafenib only improves overall survival by approximately 3 months in patients with advanced HCC. Besides, BCLC treatment algorithm does not provide different therapeutic recommendations for different degree of PVTT, and only supports single treatment option for each stage of HCC rather than a combination of comprehensive treatments, which limited individual and best care for every HCC-PVTT patients. In the past few years, many surgeons do not restrict surgical resection to HCC with PVTT. There have been new reports demonstrated that surgical treatment is feasible for selected HCC-PVTT patients with resectable tumor and moderate liver function to prolong survival period and elevate life quality as long as PVTT limited to the first-order branch, whereas non-surgical treatments fail to provide comparable therapeutic effects. At present, guidelines on HCC management from mainland China, Japan, and Hong Kong have been updated and a consensus of Asia-Pacific experts has established that portal venous invasion is not an absolute contradiction of surgical resection for HCC. This review summarized the emerging data on surgical resection for HCC-PVTT patients beyond the BCLC treatment algorithms and discussed recent therapeutic conceptualchanges in the Asia-Pacific region.

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Functional remnant liver assessment predicts liver‐related morbidity after hepatic resection in patients with hepatocellular carcinoma

Abstract: Remnant functional liver volume using computed tomography liver volumetry and EOB-MRI was a significantly useful predictor for liver-related morbidity after hepatic resection in patients with HCC.

Cited by 35 publications

References 23 publications

Post-hepatectomy liver failure after major hepatic surgery: not only size matters

Post-hepatectomy liver failure after major hepatic surgery: not only size matters

Non-Invasive Characterization of Liver Disease : By Multimodal Quantitative Magnetic Resonance

Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms: a review and update

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