Predictive value of gadoxetic acid enhanced magnetic resonance imaging for posthepatectomy liver failure after a major hepatectomy

Orimo, Tatsuya; Kamiyama, Toshiya; Kamachi, Hirofumi; Shimada, Shingo; Nagatsu, Akito; Asahi, Yoh; Sakamoto, Yuzuru; Abo, Daisuke; Taketomi, Akinobu

doi:10.1002/jhbp.769

Cited by 11 publications

(11 citation statements)

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“…Briefly, in the study participation domain, three studies were marked as high risk as they had a limited number of participants (< 50 cases) coming from a single center and also did not state whether the patients were enrolled consecutively or not [ 20 , 22 , 33 ]. In the domain of prognostic factor measurement, three studies were labeled as high risk of bias as they did not demonstrate the interval between MRI exam and hepatectomy, the number of reviewers, and whether blinded to the clinical outcome or not [ 26 , 29 , 31 ]. Regarding the outcome measurement domain, one study showed moderate risk as it applied a less-common criterion for PHLF in which a subjective index, encephalopathy, was included [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…The sensitivity and specificity were calculated in eleven studies (11/15), varying from 75 to 100% and from 54 to 93%, respectively. Eleven studies (11/15) supplied optimal cutoff values, among which one study verified it using a separate validation cohort with an accuracy of 0.80 [ 29 ]; another study yielded a sensitivity of 89% and a specificity of 92% in the validation cohort [ 31 ]. Detailed information about predictive accuracy of PHLF evaluated by gadoxetic acid–enhanced MRI parameters is listed in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

“…All studies were conducted in single centers. Table 1 illustrates the study characteristics of included studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33]35].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Predictive value of gadoxetic acid–enhanced MRI for posthepatectomy liver failure: a systematic review

Wang

Sparrelid

et al. 2021

Eur Radiol

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Objectives Effective and non-invasive biomarkers to predict and avoid posthepatectomy liver failure (PHLF) are urgently needed. This systematic review aims to evaluate the efficacy of gadoxetic acid–enhanced MRI-derived parameters as an imaging biomarker in preoperative prediction of PHLF. Methods A systematic literature search was performed in the databases of PubMed/Medline, Web of Science, Embase, and Cochrane Library up to 11 December 2020. Studies evaluating the incidence of PHLF on patients who underwent hepatectomy with preoperative liver function assessment using gadoxetic acid–enhanced MRI were included. Data was extracted using pre-designed tables. The Quality In Prognostic Studies (QUIPS) tool was adopted to evaluate the risk of bias. Results A total of 15 studies were identified for qualitative synthesis and most studies were marked as low to moderate risk of bias in each domain of QUIPS. The most commonly used parameter was relative liver enhancement or its related parameters. The reported incidence of PHLF ranged from 3.9 to 40%. The predictive sensitivity and specificity of gadoxetic acid–enhanced MRI parameters varied from 75 to 100% and from 54 to 93% in ten reported studies. A majority of the studies revealed that the gadoxetic acid–enhanced MRI parameter was a predictor for PHLF. Conclusions Gadoxetic acid–enhanced MRI showed a high predictive capacity for PHLF and represents a promising imaging biomarker in prediction of PHLF. Multicenter, prospective trials with large sample size and reliable, unified liver function parameters are required to validate the efficacy of individual liver function parameters. Key Points • There is an obvious heterogeneity of the published studies, not only in variance of MRI liver function parameters but also in indication and extent of the liver resection. • Signal intensity (SI)–based parameters derived from gadoxetic acid–enhanced MRI are the commonly used method for PHLF prediction. • Gadoxetic acid–enhanced MRI-derived parameters showed high predictive efficacy for PHLF and can potentially serve as a predictor for the incidence of PHLF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Predictive value of gadoxetic acid–enhanced MRI for posthepatectomy liver failure: a systematic review

Wang

Sparrelid

et al. 2021

Eur Radiol

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“…Although some patients with an rHUI value greater than 0.410 had PHLF grade A, the incidence of PHLF of all grades was almost inversely proportional to the rHUI value ( r = –0.743, P = 0.013). Several studies 23 , 29 , 30 have reported that the parameters determined from EOB-MRI could predict PHLF in patients who underwent hepatectomy more accurately after adjusting for bodyweight (BW, kg) or body surface area (BSA, m 2 ). However, neither BW nor BSA improved the accuracy of rHUI for predicting grade B or C PHLF in the present cohort (AUC for rHUI adjusted for BW 0.595, for rHUI adjusted for BSA 0.622) ( Fig.…”

Section: Resultsmentioning

confidence: 99%

Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy

et al. 2021

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Background Functional assessment of the future liver remnant (FLR) after major hepatectomy is essential but often difficult in patients with biliary malignancy, owing to obstructive jaundice and portal vein embolization. This study evaluated whether a novel index using gadoxetate disodium-enhanced MRI (EOB-MRI) could predict posthepatectomy liver failure (PHLF) after major hepatectomy for biliary malignancy. Methods The remnant hepatocellular uptake index (rHUI) was calculated in patients undergoing EOB-MRI before major hepatectomy for biliary malignancy. Receiver operating characteristic (ROC) curve analyses were used to evaluate the accuracy of rHUI for predicting PHLF grade B or C, according to International Study Group of Liver Surgery criteria. Multivariable logistic regression analyses comprised stepwise selection of parameters, including rHUI and other conventional indices. Results This study included 67 patients. The rHUI accurately predicted PHLF (area under the curve (AUC) 0.896). A cut-off value for rHUI of less than 0.410 predicted all patients who developed grade B or C PHLF. In multivariable analysis, only rHUI was an independent risk factor for grade B or C PHLF (odds ratio 2.0 × 103, 95 per cent c.i. 19.6 to 3.8 × 107; P < 0.001). In patients who underwent preoperative portal vein embolization, rHUI accurately predicted PHLF (AUC 0.885), whereas other conventional indices, such as the plasma disappearance rate of indocyanine green of the FLR and FLR volume, did not. Conclusion The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

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“…Tsuruga et al reported that both the volume and function after PVE need to be measured to determine the optimal timing and surgical method of hepatic resection because of the functional transition lagging behind the increase in FLR (19) . 99m Tc-GSA combined with CT volumetry or gadoxetic acid-enhanced magnetic resonance imaging is useful for predicting the FLR (19) , (22) . Although the postoperative outcome after hepatic resection has been improved through various means, the rate of postoperative mortality or morbidity remains high.…”

Section: _ocurrence and Prevention Of Postoperative Complications After Hepatic Resection In Japanmentioning

confidence: 99%

Hepatic Resection for Hepatocellular Carcinoma in the Era of Molecular-targeted Agents and Immune Checkpoint Inhibitors in Japan

Taketomi

2021

JMA J

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Hepatic resection or liver transplantation for hepatocellular carcinoma (HCC) represents the only chance for achieving a cure. For the past several decades in Japan, aggressive hepatic resection has been performed for advanced HCC, with consequent good outcomes. According to the 21st Nationwide Follow-Up Survey of Primary Liver Cancer in Japan, 38.3% of patients were treated with hepatic resection or liver transplantation as the initial treatment. The median overall survival of patients who underwent surgery was 57.0 months, and the 5- and 10-year survival rates were 48.4% and 25.2%, respectively. Since 1964, a total of 10,038 liver transplants (595 deceased-donor and 9,443 living-donor transplants) have been performed in Japan. Neoplastic disease, including HCC, was reported to be the third-most common cause of liver transplantation, and the cumulative 1-, 3-, 5-, and 10-year survival rates of living-donor liver transplants for HCC were 85.0%, 76.2%, 70.9%, and 63.1%, respectively. However, molecular-targeted agents, including sorafenib and lenvatinib, have recently been developed. Furthermore, a significantly longer survival with atezolizumab, which is an immune checkpoint inhibitor, plus bevacizumab was observed compared with sorafenib for unresectable HCC patients. Herein, we review the current status of hepatic resection and liver transplantation for HCC in Japan and discuss the role of hepatic resection in the era of molecular-targeted agents and immune checkpoint inhibitors, as well as the need for a definition of borderline resectable-HCC.

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Predictive value of gadoxetic acid enhanced magnetic resonance imaging for posthepatectomy liver failure after a major hepatectomy

Cited by 11 publications

References 30 publications

Predictive value of gadoxetic acid–enhanced MRI for posthepatectomy liver failure: a systematic review

Predictive value of gadoxetic acid–enhanced MRI for posthepatectomy liver failure: a systematic review

Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy

Hepatic Resection for Hepatocellular Carcinoma in the Era of Molecular-targeted Agents and Immune Checkpoint Inhibitors in Japan

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