Preoperative Remnant Liver Function Evaluation Using a Routine Clinical Dynamic Gd-EOB-DTPA-Enhanced MRI Protocol in Patients with Hepatocellular Carcinoma.

Background: To investigate the clinical feasibility of preoperative routine clinical dynamic Gd-EOB-DTPA-enhanced MRI alone to predict post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). Methods: 116 patients with HCC who underwent liver resection in Southwest Hospital from 2014 through 2017 were selected in this retrospective cohort study. The remnant function (RF) of the liver RF_UR and RF_RE15 were calculated by the sum of the uptake rate (UR) or relative enhancement at 15 min (RE15) from dynamic Gd-EOB-DTPA-enhanced MR images in the remnant liver regions, and standardized by standard liver volume (SLV) to generate sRF_UR (standardized RF_UR) and sRF_RE15 (standardized RF_RE15). Student's t test or Mann–Whitney U test, logistic regression, and ROC analyses were used to test the associations of preoperative RF_UR, sRF_UR, RF_RE15, sRF_RE15, the remnant liver volume (RLV)/SLV, ICG retention rate at 15 min (ICG R15) and sRF_ICG-K [ICG clearance rate (ICG-K) × RLV/SLV] with PHLF. Results: 28 patients were found to have PHLF, who showed lower RF_UR, sRF_UR, RF_RE15, sRF_RE15, RLV/SLV, sRF_ICG-K, and higher ICG R15 than patients without PHLF (p < 0.001 for all). After adjusting for clinical parameters, RF_UR (p = 0.001), sRF_UR (p = 0.001), RF_RE15 (p = 0.002), or sRF_RE15 (p = 0.003) was found to be independently significant indicator in multivariable logistic regression, respectively. RF_UR (0.882) and sRF_UR (0.882) had larger AUCs than RLV/SLV (0.731, p = 0.008; p = 0.005), ICG R15 (0.765, p = 0.039; p = 0.044) and sRF_ICG-K (0.767, p = 0.031; p = 0.023). RF_RE15 (0.845) and sRF_RE15 (0.839) had larger AUCs than RLV/SLV (0.731, p = 0.027; p = 0.025). Conclusions: The remnant liver function parameters preoperatively estimated from a routine clinical dynamic Gd-EOB-DTPA-enhanced MRI protocol can predict PHLF in patients with HCC, and may be better predictors than conventional methods. [ABSTRACT FROM AUTHOR]