Tomoelastography based on multifrequency MR elastography predicts liver function reserve in patients with hepatocellular carcinoma: a prospective study

Abstract

Background Estimating liver function reserve is essential for preoperative surgical planning and predicting post-hepatectomy complications in patients with hepatocellular carcinoma (HCC). We investigated hepatic viscoelasticity quantified by tomoelastography, a multifrequency magnetic resonance elastography technique, to predict liver function reserve. Methods One hundred fifty-six patients with suspected HCC (mean age, 60 ± 1 years; 131 men) underwent preoperative tomoelastography examination between July 2020 and August 2021. Sixty-nine were included in the final analysis, and their 15-min indocyanine green retention rates (ICG-R15s) were obtained to determine liver function reserve. Tomoelastography quantified the shear wave speed (c, m/s), which represents stiffness, and loss angle (φ, rad), which represents fluidity. Both were correlated with the ICG-R15. A prediction model based on logistic regression for major hepatectomy tolerance (ICG-R15 ≥ 14%) was established. Results Patients were assigned to either the ICG-R15 < 14% (n = 50) or ICG-R15 ≥ 14% (n = 19) group. Liver c (r = 0.617) and φ (r = 0.517) were positively correlated with the ICG-R15 (both p < 0.001). At fibrosis stages F1–2, φ was positively correlated with the ICG-R15 (r = 0.528; p = 0.017), but c was not (p = 0.104). At stages F3–4, c (r = 0.642; p < 0.001) and φ (r = 0.377; p = 0.008) were both positively correlated with the ICG-R15. The optimal cutoffs of c and φ for predicting ICG-R15 ≥ 14% were 2.04 m/s and 0.79 rad, respectively. The area under the receiver operating characteristic curve was higher for c (0.892) than for φ (0.779; p = 0.045). Conclusions Liver stiffness and fluidity, quantified by tomoelastography, were correlated with liver function and may be used clinically to noninvasively assess liver function reserve and stratify treatments.

Single Breath-Hold 3-Dimensional Magnetic Resonance Elastography Depicts Liver Fibrosis and Inflammation in Obese Patients

“…Thus, further acceleration might be required to achieve a shorter breath-hold duration. The potential for the single breath-hold 3D MRE sequence in multifrequency MRE of the abdomen 33,34 and its application to other organs 35,36 are of high interest and will be addressed in future work. The single breath-hold 3D MRE sequence may benefit from the mechanical wave penetration provided by the multidriver transducer 37 currently used in multifrequency MRE to generate higher quality viscoelastic maps in the abdomen.…”

Modified low-dose second window indocyanine green technique improves near-infrared fluorescence image-guided dermatofibrosarcoma protuberans resection: A randomized control trial

“…Firstly, there was a statistically significant decrease in examining time between rapid frozen-section diagnoses and NIR fluorescence imaging of specimen views (47.85 ± 10.82 min vs. 10.21 ± 3.46 min, P < 0.001). In addition, the number of surgical margins evaluated by NIRF imaging of specimen view was considerably increased compared with that by rapid frozen-section diagnosis (5.00 (5.00-5.00) vs. 13.00 (10.00-16.00), P < 0.001).…”

“…Moreover, CLI involves some controversial issues of radiation protection and occupation exposure, which limits the popularity of its clinical practice. In contrast, near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG), a fluorescent contrast dye approved by Food and Administration (FDA), has been greatly broadened from ophthalmology (11), liver surgery (12)(13)(14), sentinel lymph nodes biopsy (15), and flap transfer (16) to intraoperative navigation in all sorts of tumor resections. In 2009, Kokudo et al (17) happened to discover that hepatocellular carcinoma fluoresced strongly when these patients received a routine liver function test by intravenous injection of ICG prior to the surgery, which resulted in a clinical trial to investigate this novel fluorescent imaging techniques.…”

On the relationship between metabolic capacities and in vivo viscoelastic properties of the liver

“…Only little is known about the correlation between liver biomechanical parameters and liver metabolism. In cancer patients, liver function has been correlated with stiffness measured by ultrasound-based elastography ( Heucke et al, 2019 ) and with viscoelastic parameters measured by MRE ( Lin et al, 2022 ). However, it remains unclear which specific metabolic function may influence viscoelastic parameters in the liver and whether apparently normal livers display a range of biomechanical properties that are correlated with the variability of metabolic functions.…”