The Assessment of Regional Liver Function Before Major Hepatectomy Using Magnetic Resonance Imaging

Kudo, Masashi; Gotohda, Naoto; Sugimoto, Motokazu; Konishi, Masaru; Takahashi, Shinichiro; Kobayashi, Shin; Kobayashi, Tatsushi

doi:10.1177/00031348211011095

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…The investigation of radiological liver functional assessment using EOB-MRI has several limitations, such as timing bias in imaging, dose bias for Gd-EOB-DTPA, and protocol bias for MRI acquisitions [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…We have also reported LSR of the future remnant liver region as a reliable preoperative assessment of liver function useful for predicting PHLF [14]. However, single-center investigations of radiological liver functional assessment using EOB-MRI are not readily applicable to other institutions, because timings of the hepatobiliary phase differ from 15 to 20 min after Gd-EOB-DTPA injection, depending on the institution [14][15][16]. Other factors such as the dose bias of Gd-EOB-DTPA and protocol bias of MRI acquisitions are also limitations for universal application of radiological liver functional assessment [7,14,15,17].…”

Section: Introductionmentioning

confidence: 99%

“…The liver-to-spleen signal intensity ratio (LSR), which is evaluated by EOB-MRI in the hepatobiliary phase, has been used as a parameter to assess regional liver function [12,13]. We have also reported LSR of the future remnant liver region as a reliable preoperative assessment of liver function useful for predicting PHLF [14]. However, single-center investigations of radiological liver functional assessment using EOB-MRI are not readily applicable to other institutions, because timings of the hepatobiliary phase differ from 15 to 20 min after Gd-EOB-DTPA injection, depending on the institution [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…However, single-center investigations of radiological liver functional assessment using EOB-MRI are not readily applicable to other institutions, because timings of the hepatobiliary phase differ from 15 to 20 min after Gd-EOB-DTPA injection, depending on the institution [14][15][16]. Other factors such as the dose bias of Gd-EOB-DTPA and protocol bias of MRI acquisitions are also limitations for universal application of radiological liver functional assessment [7,14,15,17]. Federico et al described the key disadvantage of liver functional assessment using EOB-MRI as the need for speci c competence and that almost all previous studies were single-center investigations [7].…”

Section: Introductionmentioning

confidence: 99%

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Liver functional assessment using time-associated change in the liver-to-spleen signal intensity ratio on enhanced magnetic resonance imaging: a retrospective study

Kudo

Gotohda

Sugimoto

et al. 2022

Preprint

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Background Liver-to-spleen signal intensity ratio (LSR) is evaluated by magnetic resonance imaging (MRI) in the hepatobiliary phase, and has been reported as a useful radiological assessment of regional liver function. However, LSR is a passive (non-time-associated) liver functional assessment, but not a dynamic (time-associated) assessment. Moreover, LSR has several limitations such as dose bias of contrast medium and the timing bias of imaging. Previous studies have reported the advantages of time-associated liver functional assessment as a precise assessment of liver function. For instance, the indocyanine green (ICG) disappearance rate, which is calculated from the serum ICG concentration at multiple time points, reflects a precise preoperative liver function for predicting post-hepatectomy liver failure without the dose bias of ICG or the timing bias of blood sampling. The aim of this study was to develop a novel time-associated radiological assessment of liver function. Methods A total of 279 pancreatic cancer patients were evaluated for investigating fundamental time-associated changes of LSR in normal liver. We defined the time-associated radiological assessment of liver function, calculated using information on LSR from four time points, as the “LSR increasing rate” (LSRi). We then investigated correlations between LSRi and previous liver functional parameters. Furthermore, we evaluated how timing bias and protocol bias affect LSRi. Results Significant correlations were observed between LSRi and previous liver functional parameters such as total bilirubin, Child-Pugh grade, and albumin-bilirubin grade (P < 0.001 each). Conversely, the protocol bias of MRI acquisitions does not significantly affect LSRi. Moreover, considerably high correlations were observed between LSRi calculated by four time points and that calculated by three time points (r > 0.973 each), indicating that the timing bias of imaging was minimal. Conclusions This is the first report to propose time-associated assessment of radiological liver function. Changes in LSR over time may provide a superior preoperative assessment of regional liver function for predicting post-hepatectomy liver failure than any other radiological liver functional assessments using the hepatobiliary phase alone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Liver functional assessment using time-associated change in the liver-to-spleen signal intensity ratio on enhanced magnetic resonance imaging: a retrospective study

Kudo

Gotohda

Sugimoto

et al. 2022

Preprint

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Liver functional assessment using time-associated change in the liver-to-spleen signal intensity ratio on enhanced magnetic resonance imaging: a retrospective study

et al. 2023

Self Cite

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Background Liver-to-spleen signal intensity ratio (LSR) is evaluated by magnetic resonance imaging (MRI) in the hepatobiliary phase and has been reported as a useful radiological assessment of regional liver function. However, LSR is a passive (non-time-associated) assessment of liver function, not a dynamic (time-associated) assessment. Moreover, LSR shows limitations such as a dose bias of contrast medium and a timing bias of imaging. Previous studies have reported the advantages of time-associated liver functional assessment as a precise assessment of liver function. For instance, the indocyanine green (ICG) disappearance rate, which is calculated from serum ICG concentrations at multiple time points, reflects a precise preoperative liver function for predicting post-hepatectomy liver failure without the dose bias of ICG or the timing bias of blood sampling. The aim of this study was to develop a novel time-associated radiological liver functional assessment and verify its correlation with traditional liver functional parameters. Methods A total of 279 pancreatic cancer patients were evaluated to clarify fundamental time-associated changes to LSR in normal liver. We defined the time-associated radiological assessment of liver function, calculated using information on LSR from four time points, as the “LSR increasing rate” (LSRi). We then investigated correlations between LSRi and previous liver functional parameters. Furthermore, we evaluated how timing bias and protocol bias affect LSRi. Results Significant correlations were observed between LSRi and previous liver functional parameters such as total bilirubin, Child-Pugh grade, and albumin-bilirubin grade (P < 0.001 each). Moreover, considerably high correlations were observed between LSRi calculated using four time points and that calculated using three time points (r > 0.973 each), indicating that the timing bias of imaging was minimal. Conclusions This study propose a novel time-associated radiological assessment, and revealed that the LSRi correlated significantly with traditional liver functional parameters. Changes in LSR over time may provide a superior preoperative assessment of regional liver function that is better for predicting post-hepatectomy liver failure than LSR using the hepatobiliary phase alone.

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Predictors of Post-Hepatectomy Liver Failure in Klatskin Tumors: The Role of Preoperative Glucose, Future Liver Remnant to Spleen Ratio, and Early Bilirubin Monitoring

Kim,

Ku,

Moon

et al. 2024

Diagnostics

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Background: Post-hepatectomy liver failure (PHLF) is a serious complication following hepatic resection for Klatskin tumors, significantly affecting patient prognosis. Identifying reliable preoperative and early postoperative predictors of PHLF can help optimize patient outcomes and guide surgical planning. Method: We conducted a retrospective review of 34 patients who underwent hemi-hepatectomy for extrahepatic cholangiocarcinoma at Kosin University Gospel Hospital between April 2019 and April 2024, and at Chonnam National University Hwasun Hospital between September 2017 and April 2024. Demographics, laboratory data, and volumetric measurements including spleen volume, were analyzed to assess their roles in predicting PHLF. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive value of these factors. Results: Elevated preoperative glucose levels and reduced future liver remnant to spleen ratio (FLR/SV) were significantly associated with an increased risk of PHLF. Additionally, elevated postoperative day 1 total bilirubin (POD 1 TB) was identified as a key postoperative predictor of PHLF. Multivariable analysis confirmed the significance of these factors, with FLR/SV, preoperative glucose, and POD 1 TB demonstrating good discriminative ability in ROC analysis, with AUC values of 0.779, 0.782, and 0.786 respectively. Conclusion: Preoperative glucose control, evaluation of FLR/SV, and early postoperative monitoring of TB are useful for improving outcomes in patients undergoing major hepatectomy for Klatskin tumors.

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The Assessment of Regional Liver Function Before Major Hepatectomy Using Magnetic Resonance Imaging

Cited by 3 publications

References 16 publications

Liver functional assessment using time-associated change in the liver-to-spleen signal intensity ratio on enhanced magnetic resonance imaging: a retrospective study

Liver functional assessment using time-associated change in the liver-to-spleen signal intensity ratio on enhanced magnetic resonance imaging: a retrospective study

Liver functional assessment using time-associated change in the liver-to-spleen signal intensity ratio on enhanced magnetic resonance imaging: a retrospective study

Predictors of Post-Hepatectomy Liver Failure in Klatskin Tumors: The Role of Preoperative Glucose, Future Liver Remnant to Spleen Ratio, and Early Bilirubin Monitoring

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