An extended dysfunctional area in the congestive area of the remnant liver after hemi‐hepatectomy with middle hepatic vein resection for liver cancers evaluated on the gadoxetic acid disodium‐enhanced magnetic resonance imaging

Mu, Han; Ariizumi, Shun‐ichi; Katagiri, Seiji; Egawa, Hiroto; Yamamoto, Masakazu

doi:10.1002/jhbp.5

Cited by 7 publications

(6 citation statements)

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“…After right or left hepatectomy with middle hepatic vein (MHV) resection, the drainage area of the MHV becomes congestive. In our study, after hemihepatectomy with MHV resection, the dysfunctional rate (rate of dysfunctional volume to entire remnant liver volume) was significantly larger than the congestive rate (rate of congestive volume to entire remnant liver volume) [2]. Previously, spontaneous improvement of venous congestion at one month after hepatectomy with MHV resection has been reported [3][4][5].…”

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“…We appreciate the comments from Kawaguchi et al [1] regarding our article "An extended dysfunctional area in the congestive area of the remnant liver after hemi-hepatectomy with middle hepatic vein resection for liver cancers evaluated on the gadoxetic acid disodium-enhanced magnetic resonance imaging" [2].…”

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“…

We appreciate the comments from Kawaguchi et al [1] regarding our article "An extended dysfunctional area in the congestive area of the remnant liver after hemi-hepatectomy with middle hepatic vein resection for liver cancers evaluated on the gadoxetic acid disodium-enhanced magnetic resonance imaging" [2].After right or left hepatectomy with middle hepatic vein (MHV) resection, the drainage area of the MHV becomes congestive. In our study, after hemihepatectomy with MHV resection, the dysfunctional rate (rate of dysfunctional volume to entire remnant liver volume) was significantly larger than the congestive rate (rate of congestive volume to entire remnant liver volume) [2]. Previously, spontaneous improvement of venous congestion at one month after hepatectomy with MHV resection has been reported [3-5].

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Reply to Norihiro Kokudo et al. Regional liver function is not “zero” in the congestive area after hepatectomy with middle hepatic vein resection

Ariizumi

Yamamoto

2013

J Hepato Biliary Pancreat

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We appreciate the comments from Kawaguchi et al. [1] regarding our article "An extended dysfunctional area in the congestive area of the remnant liver after hemi-hepatectomy with middle hepatic vein resection for liver cancers evaluated on the gadoxetic acid disodium-enhanced magnetic resonance imaging" [2].After right or left hepatectomy with middle hepatic vein (MHV) resection, the drainage area of the MHV becomes congestive. In our study, after hemihepatectomy with MHV resection, the dysfunctional rate (rate of dysfunctional volume to entire remnant liver volume) was significantly larger than the congestive rate (rate of congestive volume to entire remnant liver volume) [2]. Previously, spontaneous improvement of venous congestion at one month after hepatectomy with MHV resection has been reported [3-5]. The congestive area was larger in the earlier period after hepatectomy compared to that at several months. On the other hand, impairment of liver regeneration of the congestive area at several months has been reported [4,[6][7][8]. Degeneration and necrosis of hepatocytes were seen in the congestive area in a previous report and our animal model [3,9]. Considering these reports, the period of improvement may differ in the congestive and dysfunctional areas, since congestion is a hemodynamic change, whereas dysfunction is damage of hepatocytes. The congestive area may be larger in the earlier period after hepatectomy compared to that in the median period of 3 weeks. Therefore, the congestive rate was smaller than the dysfunctional rate in the median period of 3 weeks after hepatectomy.In our study, all patients had liver cancers, which were suspected to invade the MHV on preoperative imaging findings. In this situation, congestion or dysfunction may occur due to the liver cancers preoperatively. Therefore, we compared the pre-and postoperative uptake of gadoxetic acid disodium (EOB) in the same area. Of course, postoperative up-take of EOB in the congestive and non-congestive areas after hepatectomy was compared in the same patient. Therefore, 16 of 18 patients showed low intensity in the congestive area of the remnant liver after hepatectomy.As shown in figures 1 and 2, there was a slight difference of intensity in the dysfunctional area even in the same patient. Therefore, several EOB uptakes in the dysfunctional area were measured in each patient, and the lowest EOB uptake value was selected in each patient. Regional EOB uptake could not be measured since EOB-MRI can not determine the territory of elective hepatic veins like in 3D-computed tomography.What is the regional liver function in the congestive area in the earlier period after right or left hepatectomy with MHV resection? This is our simple clinical question.

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Reply to Norihiro Kokudo et al. Regional liver function is not “zero” in the congestive area after hepatectomy with middle hepatic vein resection

Ariizumi

Yamamoto

2013

J Hepato Biliary Pancreat

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“…First, it is possible to assess the region of the remnant hepatic congestion by CT and MRI [5, 22, 23]. Regions in which major lesion of the hepatic vein has been severed to make drainage impossible have shown low signal as a congestion region by contrast‐enhanced abdominal CT examination.…”

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Comparison of Regeneration of Remnant Liver After Hemihepatectomy with or Without the Middle Hepatic Vein

et al. 2017

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We have read with great interest the article by Mu et al demonstrating that portal uptake of gadoxetic acid disodium (EOB) on magnetic resonance (MR) imaging in the congestive areas caused by venous occlusion after hemihepatectomy decreased to 65 ± 20% (mean ± SD) of that in the preoperative hepatic parenchyma [1]. In that study, multivariate analyses indicated that tumor invasion of the root of the middle hepatic vein (MHV) was an independent predictor for a larger dysfunctional area.We also intraoperatively evaluated portal uptake function in the venous congestive areas of the remnant liver, using fluorescence imaging following intravenous injection of indocyanine green (ICG) [2].

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Estimation of portal uptake function in the venous congestive area after hemi‐hepatectomy: postoperative contrast‐enhanced magnetic resonance imaging and intraoperative indocyanine green‐fluorescence imaging

Kawaguchi

Ishizawa

Kokudo

2013

J Hepato Biliary Pancreat

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We have read with great interest the article by Mu et al. demonstrating that portal uptake of gadoxetic acid disodium (EOB) on magnetic resonance (MR) imaging in the congestive areas caused by venous occlusion after hemihepatectomy decreased to 65 ± 20% (mean ± SD) of that in the preoperative hepatic parenchyma [1]. In that study, multivariate analyses indicated that tumor invasion of the root of the middle hepatic vein (MHV) was an independent predictor for a larger dysfunctional area.We also intraoperatively evaluated portal uptake function in the venous congestive areas of the remnant liver, using fluorescence imaging following intravenous injection of indocyanine green (ICG) [2]. In our series, portal uptake of ICG in the congestive areas was approximately 40% (range, 10% to 80%) of that in the non-congestive areas. In addition, regional differences in the portal uptake of ICG were observed in the congestive area probably due to the extent of venous communication, even in living donors without any veno-occlusive lesions around the MHV. Our results raise several questions regarding the findings reported by Mu et al.First, Mu et al. demonstrated that hepatic dysfunctional areas were larger than the extent of congestive areas that was estimated based on T2 weighted MR imaging. This finding is difficult to understand, because postoperative hepatic dysfunction caused by venous occlusion should develop within the areas drained by the corresponding hepatic veins (congestive area). These findings would suggest that postoperative hepatic dysfunction can extend outside the areas drained by the sacrificed hepatic veins. We assume that the slight-to-mild venous congestion unidentifiable on postop-erative T2 weighted MR images may be present throughout the entire hepatic dysfunctional areas. Second, portal uptake of EOB in the congestive and non-congestive areas should have been compared on the same hepatobiliary-phase MR images, not in comparison to preoperative MR images, since signal intensities may be affected by several factors, including hepatic regeneration, fatty infiltration, and MR imaging settings. Last, the authors should report whether there were any regional differences in the uptake of EOB in the congestive areas of each patient.We believe that application of EOB-enhanced MR imaging for evaluating postoperative liver function in congestive areas may enhance the safety of liver surgery. Intraoperative ICG-fluorescence imaging is also recommended to determine the need for venous reconstruction during surgery, because it provides more reliable and realtime information on portal uptake function in congestive areas, especially since portal uptake can be affected by factors other than tumor invasion of the MHV [2].Conflict of interest None declared.

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An extended dysfunctional area in the congestive area of the remnant liver after hemi‐hepatectomy with middle hepatic vein resection for liver cancers evaluated on the gadoxetic acid disodium‐enhanced magnetic resonance imaging

Abstract: Hemi-hepatectomy with MHV resection for liver cancers should be performed considering the dysfunctional area in the remnant liver, which is associated with tumor invasion to the root of the MHV.

Cited by 7 publications

References 25 publications

Reply to Norihiro Kokudo et al. Regional liver function is not “zero” in the congestive area after hepatectomy with middle hepatic vein resection

Reply to Norihiro Kokudo et al. Regional liver function is not “zero” in the congestive area after hepatectomy with middle hepatic vein resection

Comparison of Regeneration of Remnant Liver After Hemihepatectomy with or Without the Middle Hepatic Vein

Estimation of portal uptake function in the venous congestive area after hemi‐hepatectomy: postoperative contrast‐enhanced magnetic resonance imaging and intraoperative indocyanine green‐fluorescence imaging

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