gadoxetic-acid-disodium and Postoperative-Complications

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.. 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.. 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.. 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.. • 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.

Topics: Contrast Media; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Multicenter Studies as Topic; Postoperative Complications; Prospective Studies; Retrospective Studies

Biliary-enteric anastomosis is a common surgical procedure performed for the management of a variety of benign and malignant diseases. This procedure presents a high risk of developing complications such as anastomotic leak, hemorrhage, cholangitis, stones, stricture formation, that have been reported as ranging from 3 % to 43 %. Because the endoscopic approach of the biliary tract is generally precluded in this setting, there is clearly a role for a non-invasive imaging technique to follow up these patients and to detect the possible complications. T2-weighted MR cholangiography has been shown to be effective in the evaluation of patients with biliary-enteric anastomosis. Some of these patients may have mild duct dilatation in spite of a patent anastomosis, and stenosis should be considered only when duct dilatation is associated with narrowing of the anastomotic site. T2-weighted MRC depicts the site of biliary-enteric anastomosis, the cause of obstruction, and the status of the biliary ducts upstream. However, the disadvantages of conventional MRC are that it lacks functional information and so, differentiation between obstructive and non-obstructive dilatation of the bile ducts is often extremely difficult. T1-weighted contrast-enhanced MR cholangiography using Gd-EOB-DTPA is a recently emerging technique that is useful for delineating the anatomy of biliary-enteric anastomoses and detecting complications such as strictures, intraductal stones, and biliary leaks; besides, this technique can provide functional information that are extremely promising in the grading of biliary obstruction. We present the spectrum of findings of biliary-enteric anastomoses on Gd-EOB-DTPA-enhanced MR cholangiography focusing on the main clinical applications.

Topics: Anastomosis, Surgical; Anastomotic Leak; Biliary Tract Diseases; Cholangiopancreatography, Magnetic Resonance; Cholelithiasis; Constriction, Pathologic; Contrast Media; Gadolinium DTPA; Humans; Postoperative Complications

Bile leaks occurring after complex liver resection and lasting >1 week (grade B) usually are managed by means of invasive cholangiography either endoscopic or percutaneous, with a substantial risk of procedure-related complications. The aim of this study was to investigate the ability of gadoxetic acid disodium-enhanced magnetic resonance cholangiography to detect postoperative biliary leaks and avoid invasive cholangiography in case of peripheral location of the fistula.. Patients with grade B biliary leak after complex liver resection from January 2018 to March 2020 underwent magnetic resonance cholangiography to guide the management of the leak (study group). The primary endpoint was the ability of magnetic resonance cholangiography to reduce the need for invasive cholangiography with respect to similar posthepatectomy leaks collected in the previous 2 years and approached with upfront invasive cholangiography (controls). A series of in-hospital outcomes also were compared.. Out of 533 liver resections, 11 study patients versus 11 control patients with grade B leaks were compared. Magnetic resonance cholangiography achieved 100% accuracy in detection and location of the leak. Five out of 6 peripheral leaks healed without invasive cholangiography. Overall, 50% reduction in the use of invasive cholangiography was observed in the study versus control patients. Median healing time and hospital stay were 38 and 40 days in patients undergoing invasive cholangiography versus 10 and 11 days in patients treated conservatively (P = .007 and 0.012, respectively). Infection rate and other complications rate were 82% vs 20% (P = .01) and 35% vs 40% (P = .5), respectively.. Magnetic resonance cholangiography is a safe, precise, noninvasive tool to detect posthepatectomy bile leaks that can help clinicians in decision-making on conservative versus invasive treatment of fistulas.

Topics: Adult; Aged; Bile; Biliary Tract Diseases; Cholangiography; Cohort Studies; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications

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.. 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.. 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.. The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Postoperative Complications; Retrospective Studies

Gd-EOB-DTPA-enhanced magnetic resonance imaging (EOB-MRI) can be used for evaluating liver functional reserve. We assessed whether functional remnant liver volumetry (FRLV) using EOB-MRI predicted post-hepatectomy liver failure (PHLF) in resection of more than one segment.. We retrospectively analyzed 155 cases of hepatectomy of more than one segment. For assessment of FRLV, signal intensity (SI) of remnant liver was measured in T1-weighted images. Functional remnant liver score was derived by division of SI of liver by SI of muscle (or spleen), resulting in liver-to-muscle ratio (LMR) and liver-to-spleen ratio (LSR). FRLV were calculated by multiplying LMR (or LSR) and remnant liver volume. We investigated preoperative factors predicting PHLF (≥grade B) in study cohort (all cases except for portal vein embolization [PVE], n = 129) and validation cohort (PVE cases, n = 26).. In study cohort, PHLF occurred in 5 patients (3.9%). In multivariate analysis, FRLV (LMR) was the most reliable predictor of PHLF (P = 0.013). The cutoff value of FRLV (LMR) predicting PHLF was 615 mL/m. FRLV using LMR could precisely predict PHLF of more than one segment, and was useful even in patients who underwent PVE.

Topics: Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Postoperative Complications; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Treatment Outcome

Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma (HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.. To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.. For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.. Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure (area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure (area under the curve: 0.894; 95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model (integrated discrimination improvement = 0.117,. A radiomics-based model of preoperative gadoxetic acid-enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Feasibility Studies; Female; Gadolinium DTPA; Hepatectomy; Hepatitis B virus; Hepatitis B, Chronic; Humans; Image Processing, Computer-Assisted; Liver; Liver Cirrhosis; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nomograms; Postoperative Complications; Preoperative Period; Retrospective Studies; ROC Curve; Young Adult

Accurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion.. Forty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF.. Nine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF.. Gadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Failure; Liver Function Tests; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Portal Vein; Postoperative Complications; Retrospective Studies; ROC Curve

To assess the efficacy of functional MR image with volumetric, liver function test and indocyanine green clearance (ICG) in identifying the patients who are at risk of post-hepatectomy liver failure (PHLF).. We retrospectively included 115 patients undergoing gadoxetic acid-enhanced MR imaging before hepatectomy at one medical centre from January 2013 to December 2015. Contrast enhancement ratio (CER) between transitional and hepatobiliary phases (3 and 30 minutes post-contrast) was calculated. Total liver volume (TLV) and spleen volume (Sp) were measured. Post-operatively, the histological Ishak fibrosis score was collected. Potential risk factors for liver failure were analysed, and the performance was examined by receiver operating characteristic curve.. Gadoxetic acid-enhanced MR imaging with volumetric is a reliable method for evaluating functional liver volume and determining the risk of PHLF.

Topics: Adult; Aged; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Indocyanine Green; Liver; Liver Failure; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Postoperative Complications; Retrospective Studies; ROC Curve

To compare the value of functional future liver remnant (functFLR) to established clinical and imaging variables in prediction of post-hepatectomy liver failure (PHLF) after major liver resection.. This retrospective, cross-sectional study included 62 patients, who underwent gadoxetic acid enhanced MRI and MDCT within 10 weeks prior to resection of ≥ 4 liver segments. Future liver remnant (FLR) was measured in MDCT using semi-automatic software. Relative liver enhancement for each FLR segment was calculated as the ratio of signal intensity of parenchyma before and 20 min after i.v. administration of gadoxetic acid and given as mean (remnantRLE). Established variables included indocyanine green clearance, FLR, proportion of FLR, weight-adapted FLR and remnantRLE. functFLR was calculated as FLR multiplied by remnantRLE and divided by patient's weight. The association of measured variables and PHLF was tested with univariate and multivariate logistic regression analysis and receiver operator characteristics (ROC) curves compared with the DeLong method.. Sixteen patients (25.8%) experienced PHLF. Univariate logistic regression identified FLR (p = 0.015), proportion of FLR (p = 0.004), weight-adapted FLR (p = 0.003), remnantRLE (p = 0.002) and functFLR (p = 0.002) to be significantly related to the probability of PHLF. In multivariate logistic regression analysis, a decreased functFLR was independently associated with the probability of PHLF (0.561; p = 0.002). Comparing ROC curves, functFLR showed a significantly higher area under the curve (0.904; p < 0.001) than established variables.. functFLR seems to be superior to established variables in prediction of PHLF after major liver resection.. • functFLR is a parameter combining volumetric and functional imaging information, derived from MDCT and gadoxetic acid enhanced MRI. • In comparison to other established methods, functFLR is superior in prediction of post-hepatectomy liver failure. • functFLR could help to improve patient selection prior major hepatic surgery.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Gadolinium DTPA; Hepatectomy; Humans; Indocyanine Green; Liver Failure; Liver Function Tests; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Retrospective Studies

The objective of our study was to identify whether quantitative measurements from gadoxetic acid-enhanced MRI are useful for predicting posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) compared with and in combination with future remnant liver volume (FRLV) and an indocyanine green (ICG) clearance test.. Preoperative gadoxetic acid-enhanced MR images were retrospectively evaluated in 73 patients who underwent anatomic liver resection for HCC between 2011 and 2013. For quantitative measurement of hepatocyte function, relative liver enhancement (RLE) and remnant hepatocyte uptake index (rHUI) were measured using hepatobiliary phase MR images. FRLV was determined using measurements from preoperative CT scans. Univariate and multivariate analyses of measurements from gadoxetic acid-enhanced MRI, ICG clearance tests, and FRLV for finding predictors of PHLF were performed. To compare the diagnostic performance of predictors, ROC analyses were also performed.. Eighteen (25%) of 73 patients met the criteria for PHLF. Univariate analysis revealed that all measurements related to MRI including RLE, rHUI, ICG clearance, and FRLV were significantly associated with PHLF. Multivariate analysis showed that RLE, FRLV, ICG-plasma disappearance rate (ICG-PDR), rHUI, and rHUI corrected for body weight (rHUI-BW) were independent predictors of PHLF (p = 0.011, p = 0.034, p = 0.003, p < 0.001, and p = 0.001, respectively). In ROC analyses, AUCs of rHUI and rHUI-BW were larger than those of other independent predictors; the differences were statistically significant (for rHUI-BW vs RLE, ICG-PDR, and FRLV, p = 0.016, 0.007, and 0.046, respectively; for rHUI vs RLE and ICG-PDR, p = 0.045 and 0.016, respectively).. Measurements from gadoxetic acid-enhanced MRI predicted PHLF better than the ICG clearance test in patients with HCC who underwent hepatectomy.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Hepatocytes; Humans; Indocyanine Green; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Postoperative Complications; Retrospective Studies

Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC).. Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated.. IQ was high for all sequences without significant differences (2.83-2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64-96 using T2w-MRCP, increasing to 79-100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72-92% to 88-100% and 67-89% to 72-94%, respectively. Kappa values were substantial (0.45-0.62). T1w-MRC was found to be helpful in 75-83.3%.. Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications.. • T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. • Adding T1w-MRC to T2w-MRC increases diagnostic confidence for detection of biliary complications. • A combination of T1w-MRC and T2w-MRCP leads to the best results.

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Child; Child, Preschool; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Constriction, Pathologic; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Sensitivity and Specificity; Young Adult

To assess the diagnostic value of dynamic T. In each patient, visualization of bile ducts was sufficient in the HBP. The accuracy, sensitivity and specificity of dynamic Gd-EOB-DTPA-enhanced T1w MRC in the detection of biliary leaks were 92.9%, 90.5% and 100%, respectively (p < 0.001). 19 of 28 patients had bile leak findings in T1w Gd-EOB-DTPA-enhanced MRC [HBP group: N = 7 (36.8%), DP group: N = 12 (63.2%)]. There was no statistically significant difference in terms of laboratory test results and the presence of bile duct dilatation between HBP and DP group (p > 0.05). Three patients, each of them in DP group, showed normal laboratory test results and bile duct diameters.. Dynamic T1w Gd-EOB-DTPA-enhanced MRC is a useful non-invasive diagnostic tool to detect bile leak. Advances in knowledge: Prolonged DP imaging may be required for bile leak detection even if visualization of biliary tree is sufficient in HBP and liver function tests, total bilirubin levels and bile duct diameters are normal.

Topics: Adult; Aged; Bile Ducts; Biliary Tract Diseases; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Male; Middle Aged; Postoperative Complications; Reproducibility of Results; Retrospective Studies

To determine whether a combination of clinical factors, the future liver remnant (FLR) ratio, and hepatic uptake of gadoxetic acid can be used to predict post-hepatectomy liver failure (PHLF) and other major complications (OMC).. Sixty-five consecutive patients who underwent pre-hepatectomy gadoxetic acid-enhanced magnetic resonance imaging (MRI) between October 2010 and December 2013 were included. The relative liver enhancement (RLE) of gadoxetic acid was calculated from regions of interest on MRI, and FLR ratios were obtained from computed tomography (CT). PHLF and OMC were defined by the International Study Group of Liver Surgery criteria and Clavien-Dindo grade of ≥3, respectively. Multivariate logistic regression modelling was performed to identify predictors of PHLF and OMC, including RLE, FLR ratio, age, sex, chemotherapy history, intra-operative blood loss, and intra-operative transfusion.. Nine patients experienced PHLF and another nine patients experienced OMC. RLE was comparable to the FLR ratio in predicting PHLF (areas under the receiver operating characteristic [AUROC] curves, 0.665 and 0.705), but performed poorly in predicting OMCs (AUROCs, 0.556 and 0.702). Combining all clinical and imaging parameters as predictors yielded the best performing predictive models (AUROCs, 0.875 and 0.742 for PHLF and OMC, respectively).. A model based on clinical parameters, the FLR ratio, and RLE of gadoxetic acid may improve pre-hepatectomy risk assessment.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Failure; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; Young Adult

We intended to determine the usefulness of gadoxetic acid-enhanced magnetic resonance (MR) imaging on preoperative prediction of the risk of postoperative liver failure (PLF) using measurement of relative liver enhancement (RLE) in patients who underwent surgical resection of hepatocellular carcinoma (HCC).. A total of 121 HCC patients who had underwent gadoxetic acid-enhanced MRI before surgery between January 2012 and April 2015 at our hospital was retrospectively analyzed. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma in each liver segment before and 20 min after intravenous administration of gadoxetic acid. PLF was defined based on the "50-50 criteria" (prothrombin time <50% and serum bilirubin >5 mg/dL on 5 days after surgery).. Of the 121 patients, 74 (61.2%) patients had liver cirrhosis, clinically. Median tumor size 2.8 cm (range, 1-14 cm), 106 (87.6%) patients had a single HCC, and 101 (83.5%) patients had HCC within Milan criteria. Based on the "50-50 criteria", PLF was observed in 7 (5.8%) patients. Mean RLE was significantly lower in patients with PLF than those without it (55.9% vs 85.5%, P < 0.01). In a multivariate analysis, decreased RLE was a significant independent risk factor for PLF in HCC patients (odds ratio 0.97, P = 0.03). Optimal cut-off RLE value was 82.36.. RLE was significantly lower in patients with PLF than those without it. Measurement of RLE using gadoxetic acid-enhanced MR imaging before surgery can be useful for prediction of PLF in HCC patients who receive surgical treatment.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Retrospective Studies; Risk

To evaluate the use of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI)-derived fat- and liver function-measurements for prediction of future liver remnant (FLR) growth after portal vein occlusion (PVO) in patients scheduled for major liver resection.. Forty-five patients (age, 59 ± 13.9 y) who underwent Gd-EOB-DTPA-enhanced liver MRI within 24 ± 18 days prior to PVO were included in this study. Fat-Signal-Fraction (FSF), relative liver enhancement (RLE) and corrected liver-to-spleen ratio (corrLSR) of the FLR were calculated from in- and out-of-phase (n=42) as well as from unenhanced T1-weighted, and hepatocyte-phase images (n=35), respectively. Kinetic growth rate (KGR, volume increase/week) of the FLR after PVO was the primary endpoint. Receiver operating characteristics analysis was used to determine cutoff values for prediction of impaired FLR-growth.. FSF (%) showed significant inverse correlation with KGR (r=-0.41, p=0.008), whereas no significant correlation was found with RLE and corrLSR. FSF was significantly higher in patients with impaired FLR-growth than in those with normal growth (%FSF, 8.1 ± 9.3 vs. 3.0 ± 5.9, p=0.02). ROC-analysis revealed a cutoff-FSF of 4.9% for identification of patients with impaired FLR-growth with a specificity of 82% and sensitivity of 47% (AUC 0.71 [95%CI:0.54-0.87]). Patients with impaired FLR-growth according to the FSF-cutoff showed a tendency towards higher postoperative complication rates (posthepatectomy liver failure in 50% vs. 19%).. Liver fat-content, but not liver function derived from Gd-EOB-DTPA-enhanced MRI is a predictor of FLR-growth after PVO. Thus, liver MRI could help in identifying patients at risk for insufficient FLR-growth, who may need re-evaluation of the therapeutic strategy.

Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Contrast Media; Embolization, Therapeutic; Female; Forecasting; Gadolinium DTPA; Hepatectomy; Hepatocytes; Humans; Hypertrophy; Image Enhancement; Ligation; Liver; Liver Diseases; Liver Regeneration; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Postoperative Complications; Retrospective Studies; ROC Curve; Spleen; Young Adult

The aim of this study was to evaluate the prognostic potential of a 3-parameter visual scoring (qualitative score [QS]) system for hepatobiliary phase gadoxetic acid-enhanced magnetic resonance imaging (MRI) in orthotopic liver transplant grafts.. This retrospective study of 128 patients was approved by our institutional review board. Two readers independently assigned 3 QSs to T1-weighted MRI scans, 20 minutes after the administration of gadoxetic acid (hepatobiliary phase), based upon the following: (1) liver parenchymal enhancement (EnQS, 0-2); (2) biliary contrast excretion (ExQS, 0-2); and (3) signal intensity of the portal vein relative to the liver parenchyma, that is, the portal vein sign (PVsQS, 0-2). The functional liver imaging score (FLIS) was calculated as the sum score of these 3 parameters. The relative liver enhancement (RLE) was measured as well. Demographic, clinical, laboratory parameters, and imaging findings were included in univariate and multivariate statistical analyses. The primary end point was graft failure, that is, retransplantation or death from liver failure. The probability of graft survival was calculated by Kaplan-Meier estimates and Cox proportional hazards regression.. In the univariate analysis, EnQS, ExQS, PVsQS, and FLIS scores, as well as RLE, were significantly associated with the 1- to 3-year probability of graft survival (P < 0.001). For a FLIS of (0), the 3-year probability of graft survival was 6.5%, whereas it was 51.3% for a FLIS of (1-3) and 100% for a FLIS of (4-6) (P < 0.001). In the multivariate survival models, EnQS, ExQS, and PVsQS, each independently outperformed the majority of clinical and laboratory parameters, and the FLIS did even better regarding the prediction of 1- to 3-year graft survival.. In liver transplant recipients, gadoxetic acid-enhanced MRI-derived QSs (ie, EnQS, ExQS, and PVsQS), as well as the FLIS and RLE, can predict graft survival probability.

Topics: Cohort Studies; Contrast Media; Female; Gadolinium DTPA; Graft Survival; Humans; Image Enhancement; Liver; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Reproducibility of Results; Retrospective Studies

To clarify the diagnostic performance of gadoxetic acid-enhanced MRI for the detection of hepatocellular carcinoma (HCC) in recipients of living related-liver transplantation (LRLT).. This retrospective study group consisted of 15 patients with 61 HCCs who each underwent multidetector row computed tomography (MDCT), gadoxetic acid-enhanced MRI, and angiography-assisted computed tomography (CT) before LRLT. The three modalities were compared for their ability to detect HCC. Two blinded readers independently reviewed the images obtained by each modality for the presence of HCC on a segment-by-segment basis using a 5-point confidence scale. The diagnostic performance of the modalities was evaluated in a receiver operating characteristic (ROC) analysis. The area under the ROC curve (Az), sensitivity, specificity, and accuracy were compared for the three modalities.. No significant difference in Az, sensitivity, specificity, or accuracy was obtained among gadoxetic acid-enhanced MRI, MDCT, and angiography-assisted CT for both readers. For reader 1, the sensitivity (55.6%) and the accuracy (84.7%) of angiography-assisted CT were significantly higher than those of MDCT (33.3% and 78.0%) (P < 0.05).. Gadoxetic acid-enhanced MRI has a relatively high diagnostic ability to detect HCC even in recipients of LRLT, equivalent to the abilities of MDCT and angiography-assisted CT.

Topics: Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Liver Transplantation; Living Donors; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Postoperative Complications; Sensitivity and Specificity

The aims of this study were to use dynamic hepatocyte-specific contrast-enhanced MRI to evaluate liver volume and function in liver cirrhosis, correlate the results with standard scoring models and explore the inhomogeneous distribution of liver function in cirrhotic livers.. 10 patients with liver cirrhosis and 20 healthy volunteers, serving as controls, were included. Hepatic extraction fraction (HEF), input relative blood flow and mean transit time were calculated on a voxel-by-voxel basis using deconvolutional analysis. Segmental and total liver volumes as well as segmental and total hepatic extraction capacity, expressed in HEFml, were calculated. An incongruence score (IS) was constructed to reflect the uneven distribution of liver function. The Mann-Whitney U-test was used for group comparison of the quantitative liver function parameters, liver volumes and ISs. Correlations between liver function parameters and clinical scores were assessed using Spearman rank correlation.. Patients had larger parenchymal liver volume, lower hepatocyte function and more inhomogeneous distribution of function compared with healthy controls.. The study demonstrates the non-homogeneous nature of liver cirrhosis and underlines the necessity of a liver function test able to compensate for the heterogeneous distribution of liver function in patients with diseased liver parenchyma.. The study describes a new way to quantitatively assess the hepatic uptake of gadoxetate or gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid in the liver as a whole as well as on a segmental level.

Topics: Adult; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Statistics, Nonparametric

To determine if gadoxetic acid-enhanced magnetic resonance (MR) imaging with measurement of relative liver enhancement (RLE) on hepatobiliary phase images can allow preoperative assessment of the risk of liver failure after major liver resection.. The local institutional review committee approved this retrospective analysis and waived written informed consent. The study included 73 patients (39 men; median age, 64.4 years) who underwent gadoxetic acid-enhanced 3-T MR imaging before resection of three or more liver segments. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid. RLE was assessed in each liver segment and the mean value of all segments was used for analysis. Posthepatectomy liver failure was defined according to the "50-50 criteria" (ie, prothrombin time <50% and serum bilirubin >50 µmol/L on postoperative day 5) and the International Study Group of Liver Surgery (ISGLS) classification. The association of RLE and liver failure was tested with univariate and multivariate logistic regression analysis. In addition to RLE, the latter also included demographic, clinical, operative, and histologic variables.. Patients with liver failure according to the 50-50 criteria (n = 3) had significantly lower RLE (54.5%) than those without (125.6%) (P = .009). According to ISGLS criteria, RLE was 112.5% in patients with grade A liver failure (n = 20), 88.4% in patients with grade B (n = 7), 41.7% (n = 2) in patients with grade C, and 136.5% (P < .001) in those without liver failure. In a logistic regression analysis, RLE was inversely related to the probability of liver failure according to the 50-50 (P = .02) and ISGLS (P < .001) criteria. In a multivariate analysis, RLE was independently associated with a higher probability of liver failure according to ISGLS classification (P = .003).. Gadoxetic acid-enhanced MR imaging can help with the assessment of the risk for liver failure after major liver resection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bilirubin; Biomarkers; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Failure; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prothrombin Time; Retrospective Studies; Risk Assessment

We assessed the usefulness of contrast-enhanced magnetic resonance cholangiography (CE-MRC) with liver-specific contrast agent in evaluating the biliary tree after hepatic surgery.. A total of 142 patients with suspected biliary complications after liver surgery underwent hepatobiliary MR before and after administration of gadolinium ethoxy benzylic diethylenetriamine pentaacetic acid (Gd-EOB-DTPA). Unenhanced MR cholangiopancreatography (MRCP) and postcontrast MRC were obtained in all patients. Blinded image evaluation and semiquantitative analysis comparing MRCP and CE-MRC were performed by two experienced radiologists.. In all cases, optimal postcontrast visualisation of the biliary tract was obtained. In 22 patients, a postsurgical biliary complication was confirmed. MRCP detected 64% of lesions, but in 36% of cases, an alteration was only suspected but not clearly defined. CE-MRC allowed definite diagnosis in 100% of cases.. Hepatobiliary-specific contrast agents allow for accurate and extensive study of biliary tract alterations, especially in assessing postsurgical complications.

Topics: Biliary Tract Diseases; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Gadolinium DTPA; Humans; Liver; Postoperative Complications

To assess the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography for the detection of bile leaks after hepatobiliary surgery.. Twenty-three patients with symptoms suggestive of bile leak underwent conventional fat-suppressed T1- and T2-weighted MR cholangiography followed by Gd-EOB-DTPA-enhanced MR cholangiography using gradient-echo (GRE) T2-weighted sequences and fat-suppressed T1-weighted 3D gradient-echo sequences 20 min after an intravenous bolus of Gd-EOB-DTPA. The results of Gd-EOB-DTPA-enhanced MR cholangiography correlated with clinical findings, surgical repair, and the results of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.. The results of Gd-EOB-DTPA-enhanced MR cholangiography were negative in 13 patients (cholecystectomy 5, liver transplantation 2, liver resection for focal lesions 2, cholangiocarcinoma 1, and partial hepatectomy after liver injury 1). In 10 patients in whom bile leaks were detected, this complication occurred after liver resection for focal lesions in 3, cholecystectomy in 4, liver transplantation in 2, and liver resection for intrahepatic cholangiocarcinoma in 1. The diagnostic accuracy of Gd-EOB-DTPA-enhanced MR for the detection or exclusion of bile leaks was 100%.. Gd-EOB-DTPA-enhanced MR cholangiography is a highly reliable technique for the detection of bile leaks after hepatobiliary surgery and may avoid the use of other, potentially risky invasive diagnostic techniques.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Diseases; Bile Ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Male; Middle Aged; Postoperative Complications

Topics: Adolescent; Budd-Chiari Syndrome; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Follow-Up Studies; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver; Liver Failure, Acute; Liver Function Tests; Magnetic Resonance Imaging; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications; Tomography, X-Ray Computed; Ultrasonography

To investigate whether preoperative gadoxetate-disodium-enhanced MR imaging predicts posthepatectomy liver failure (PHLF) in patients who underwent major hepatic resection.. Twenty nine patients who underwent preoperative gadoxetate-disodium-enhanced MR imaging and following major hepatic resection were enrolled. Hepatic parenchymal signal intensity (SI) on pre-contrast T1-weighted imaging and 20min hepatocyte phase was measured at each of the four liver segments by two observers using region of interest measurements. The mean value was calculated and used at each phase. The relative contrast enhancement index (RCEI) was calculated: (20min hepatocyte phase SI-pre-contrast SI)/pre-contrast SI. PHLF was determined by the International Study Group of Liver Surgery 2011 guidelines. Correlation analysis was performed between preoperative liver function test and RCEI. Diagnostic accuracy of RCEI for predicting PHLF was calculated with receiver operating characteristic curve analysis. The reproducibility of the RCEI measurement was evaluated.. There was a significant correlation between preoperative albumin (r=0.496, P=0.006), T-bilirubin (r=-0.383, P=0.041), and RCEI. Seven patients (24%) experienced PHLF, and one of these patients (3%) died. The diagnostic accuracy of RCEI was 0.838 (sensitivity 85.7%, specificity 77.3%, cut-off value: 0.7508, 95% confidence interval: 0.654, 0.947). The 95% limits of agreement and ICC between repeated RCEI measurements were 18.4% of the mean and 0.94, respectively, and between RCEI measurements by the two observers were 21.7% and 0.929, respectively.. Our results show that preoperative gadoxetate-disodium-enhanced MR imaging can predict PHLF in patients who underwent major hepatic resection.

Topics: Adult; Aged; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Diseases; Liver Failure; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; ROC Curve; Statistics, Nonparametric