Pre-treatment estimation of future remnant liver function using gadoxetic acid MRI in patients with HCC

Yoon, Jeong Hee; Choi, Joonsung; Jeong, Yong Yeon; Schenk, Andrea; Chen, Longquan; Laue, Hendrik; Kim, So Yeon; Lee, Jeong Min

doi:10.1016/j.jhep.2016.07.024

Cited by 45 publications

(29 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The hepatic venous pressure gradient is considered to be a reliable marker; however, its invasiveness hinders its application. Furthermore, hepatocyte uptake ratio is able to provide information regarding the regional variation of liver function, unlike ICG R 15 (14)(15)(16)38). Thus, we believe that hepatocyte uptake ratio would be clinically useful, particularly for patients who Figure 4: Hepatocyte uptake ratio map in a 57-year-old man with hepatitis B cirrhosis and Child-Pugh class A disease reveals a hepatocyte uptake ratio value of 364 3 10 22 ; indocyanine green retention test is 14.6%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Quantitative Assessment of Liver Function by Using Gadoxetic Acid–enhanced MRI: Hepatocyte Uptake Ratio

et al. 2019

Self Cite

View full text Add to dashboard Cite

To determine whether hepatocyte uptake ratios derived at gadoxetic acid-enhanced MRI correlate with quantitative measures of liver function and can help to identify contraindication to major hepatectomy. Materials and Methods: Between August 2016 and October 2016, 50 study participants with chronic liver disease or cirrhosis underwent liver MRI at 3.0 T including T1 mapping and elastography. Liver function was quantitatively assessed by using the indocyanine green retention test (ICG R 15). T1 maps were obtained by using the Look-Locker sequence before and 10 minutes after gadoxetic acid administration (0.025 mmol/kg). The relationship between ICG R 15 and the following MRI parameters was evaluated: pre-and postcontrast T1 values of the liver, hepatocyte uptake ratio representing the amount of contrast media solely taken into hepatocytes, liver volume, and degree of enhancement at the common bile duct. Diagnostic performance of the hepatocyte uptake ratio to identify patients with ICG R 15 greater than 20% (ie, contraindication to hepatectomy) was compared with other parameters by using areas under the receiver operating characteristic curve. Results: Hepatocyte uptake ratio showed a negative correlation with ICG R 15 r of 20.78 (P , .001). In participants with chronic liver disease or Child-Pugh class A, those with ICG R 15 of 20% or less showed higher hepatocyte uptake ratio than those with ICG R 15 greater than 20% (P , .001). Hepatocyte uptake ratios demonstrated better performance for helping to detect ICG R 15 greater than 20% than did liver volume (area under the curve, 0.96 vs 0.70; P = .01). Conclusion: Hepatocyte uptake ratios are negatively correlated with liver function as measured by indocyanine green retention test and provide acceptable diagnostic performance for helping to identify participants who have contraindications to major hepatectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, ICG R 15 cannot evaluate regional variation of hepatic fibrosis (13). Therefore, imaging-based liver function estimation may prove to be a better assessment tool (14)(15)(16)(17) for the accurate estimation of liver function.…”

mentioning

confidence: 99%

Quantitative Assessment of Liver Function by Using Gadoxetic Acid–enhanced MRI: Hepatocyte Uptake Ratio

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several authors revealed that combining gadoxetic acid enhanced MRI parameters and volumetric data seems to be a promising tool in the preoperative work-up for liver surgery. Yoon and colleagues calculated a predicted liver remnant by multiplying the hepatic extraction fraction by the remnant volume, and correlated these results with post-treatment ICG-R15 [ 11 ]. They found a negative correlation, and concluded that gadoxetic acid enhanced MRI enables prediction of postoperative liver function.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

“…For this purpose, CT and MR volumetric analyses are widely performed in preoperative assessment prior to major hepatectomy (177). Moreover, functional information from gadoxetic acid-enhanced MRI has also been reported to be useful in the prediction of future remnant liver function (178,179), and US elastography or MR elastography can also provide predictive information for postoperative he-the sensitivity of brush cytology or tissue biopsy is not sufficiently high, as it was reported that the pooled sensitivity of brush cytology was only 43% (95% confidence interval: 35%, 52%) in detecting CC in patients with PSC (168), and endoscopic retrograde forceps biopsy showed sensitivities of approximately 50%-80% in malignant biliary strictures (169,170). Percutaneous transluminal forceps biopsy can also be performed via the percutaneous transhepatic biliary drainage tract, which demonstrated sensitivities of 77.2%-78.4% in malignant strictures (119,120).…”

Section: Perihilar CC Imaging Featuresmentioning

confidence: 99%

Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges

2018

Self Cite

View full text Add to dashboard Cite

Cholangiocarcinoma, the second most common hepatobiliary malignancy after hepatocellular carcinoma, is a heterogeneous disease entity with widely varying radiologic features, clinical behavior, and treatment approaches. In the detection, characterization, staging, and resectability assessment of cholangiocarcinoma, imaging studies are indispensable. Herein, an overview of the state-of-the-art imaging techniques is presented for the evaluation of intrahepatic and perihilar cholangiocarcinoma, as well as complementary multimodality and multiparametric imaging approaches for a more comprehensive evaluation. In addition, classification systems, new pathologic concepts in cholangiocarcinogenesis and premalignant lesions, and current trends in treatment approaches, which are vital to the imaging interpretation of cholangiocarcinoma, will be discussed. RSNA, 2018.

show abstract

Pre-treatment estimation of future remnant liver function using gadoxetic acid MRI in patients with HCC

Cited by 45 publications

References 32 publications

Quantitative Assessment of Liver Function by Using Gadoxetic Acid–enhanced MRI: Hepatocyte Uptake Ratio

Quantitative Assessment of Liver Function by Using Gadoxetic Acid–enhanced MRI: Hepatocyte Uptake Ratio

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

Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges

Contact Info

Product

Resources

About