Liver Intrinsic Function Evaluation (LIFE): Multi-parametric Liver Function Profiles of Patients Undergoing Hepatectomy

Abstract

For a range of liver malignancies, the only curative treatment option may be hepatectomy, which may have fatal complications. Therefore, an unbiased pre-operative risk assessment is vital, however, at present the assessment is typically based on global liver function only. Magnetic resonance imaging (MRI) modalities have the possibility to aid this assessment, by introducing additional characterization of liver parenchymal, such as non-invasive quantification of steatosis, fibrosis, and uptake function, both for global and regional assessment. To this cause, we here present a prospective observation study (LIFE), in which patients underwent extensive MR-examinations both before and after resective-surgery. A total of 13 patients undergoing hepatectomy underwent a pre- (n=13) and post (m=5) multi-modal MRI examination (within 3-5 days of the surgery) (Fig. 1B). The multimodal MR-examination included DCE, 3D-MRE, fat fraction measurements (PDFF by MRS, 6PD). Using these measurements, we also construct individual patient profiles by including conventional functional, and volumetric measurements, into a multi-parametric space. As a proof of concept, the areas of each profile, denoted multiparametric profile area (MPA, and aMPA) were calculated, to create a measurement comprising information from all modalities. At a group-level, no clear pattern emerged of MPA or aMPA between groups with different ex-tent of resection. In contrast, on a case-by-case basis, several parameters contributed to high individual MPA or aMPA-values, suggesting tissue abnormalities. With respect to regional DCE measurements, i.e., relative enhancement at 20 minutes, a clear variation between function in segments, within and between the individuals, was observed. In this combined pre- and post-observational case-based study ranging from very extensive (i) liver surgery to minor (ii), or none (iii), we aimed to describe how a multi-modal MRI examination before hepatectomy could yield valuable information for the pre-operative assessment, with a particular focus on a Couinaud-segmental level. The use of a multi-modal approach allows for a broad spectral characterization of several aspects of the remnant tissue. However, the effectiveness and clinical benefit of each parameter, and how to further optimize an abbreviated clinical MR-protocol needs to be confirmed.