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

Abstract

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.

Multimodal perioperative assessment of liver function and volume in patients undergoing hepatectomy for colorectal liver metastasis: a comparison of the indocyanine green retention test, 99mTc mebrofenin hepatobiliary scintigraphy and gadoxetic acid enhanced MRI

“…14 During the last decade, gadoxetic acid-enhanced MRI has been increasingly used for quantitative evaluation of liver function. 13,15 Previous studies have shown that parameters derived from gadoxetic acidenhanced MRI have a good correlation with the retention rate of ICG at 15 min (ICG-R15), Child-Pugh score and the Model for End-Stage Liver Disease score, 12,16,17 making it a promising tool to provide more accurate pre-operative assessment for patients with liver tumors estimating both morphological, volumetric and functional capacity. 15 Compared with the ICG test and HBS, the efficacy and consistency of gadoxetic acid-enhanced MRI remains unclear.…”

“…13,15 Previous studies have shown that parameters derived from gadoxetic acidenhanced MRI have a good correlation with the retention rate of ICG at 15 min (ICG-R15), Child-Pugh score and the Model for End-Stage Liver Disease score, 12,16,17 making it a promising tool to provide more accurate pre-operative assessment for patients with liver tumors estimating both morphological, volumetric and functional capacity. 15 Compared with the ICG test and HBS, the efficacy and consistency of gadoxetic acid-enhanced MRI remains unclear. We therefore designed a prospective pilot study to explore gadoxetic acid-enhanced MRI, along with ICG-R15 and HBS to depict the dynamic changes of the liver function and volume after hepatectomy in patients with colorectal liver metastases (CRLM), in which HBS results were adopted as the reference for assessment of liver function.…”

“…8 Numerous studies have reported encouraging results on gadoxetic acid-enhanced MRI-based prediction of post-hepatectomy liver failure. 15,24,25 In addition, gadoxetic acid-enhanced MRI supplies not only accurate anatomical information, but also reliable assessment of global and regional liver function, making it a potential "one-stop-shop" modality prior to hepatectomy. Furthermore, MRI-based liver function information can be obtained from clinical routine work-up, with no additional or .…”

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

“…Signal intensity-based parameters, including the relative liver enhancement, hepatic uptake index, 169 and liver imaging score, 170 are commonly used to evaluate liver function, and these EOB-MRIderived parameters are effective for the preoperative prediction of PHLF. 61,[171][172][173][174][175] The advantages of EOB-MRI include high spatial resolution and combined anatomical and functional assessment, which enable the evaluation of regional liver function and diagnosis of hepatic lesions prior to liver resection. Moreover, it is reasonable to incorporate the FLR volume for precise estimation of postoperative residual function.…”

Impact of sarcopenia on the future liver remnant growth after portal vein embolization and associating liver partition and portal vein ligation for staged hepatectomy in patients with liver cancer: A systematic review

“…For those patients who are not eligible for surgery, a majority of them are due to the limited future liver remnant (FLR), which is the remaining part of the liver after liver resection, and it serves as a key determinant for extended liver resection ( 3 ). FLR has to be sufficient to maintain normal physiologic function after liver resection, otherwise a lethal complication, post-hepatectomy liver failure will occur ( 4 ). To prevent the occurrence of liver failure after liver resection, the FLR volume limit should be > 20% of the total liver in a normal liver, > 30% in the abnormal liver (such as steatosis or post-chemotherapy), and at least 40% in the cirrhotic liver ( 5 ).…”