Accuracy of liver-specific magnetic resonance imaging as a predictor of chemotherapy-associated hepatic cellular injury prior to liver resection.
OBJECTIVE
To evaluate the diagnostic precision of chemical-shift imaging MRI and ferucarbotran-enhanced MRI for hepatic parenchymal injury prior to hepatic resection for colorectal metastases.


METHODS
Preoperative MRI criteria were used to score 37 patients with colorectal liver metastases by two independent radiologists, blinded to outcomes, for signal drop-out on chemical-shift imaging MRI and ferucarbotran uptake and compared to blinded standardized histopathological endpoints of steatosis, steatohepatitis and sinusoidal dilatation. Sensitivity, specificity, predictive values and the area under the receiver operating characteristic curve (AUC) were calculated for the MRI sequences.


RESULTS
On histology, severe steatosis, steatohepatitis and sinusoidal dilation were evident in 6 (16.2%), 4 (10.8%) and 9 (24.3%) patients respectively. Chemical-shift imaging MRI had a positive predictive value (PPV) of 100% for severe steatosis, 80% for steatohepatitis and zero for sinusoidal dilatation, with an AUC of 1.0, 0.99 and 0.36 respectively. Ferucarbotran-enhanced MRI had a 100% PPV for the detection of severe sinusoidal dilatation, with an AUC of 0.61.


CONCLUSIONS
This study demonstrates that liver-specific MRI can accurately predict the severity of pre-existing hepatic injury. Moreover, it may play a key role in planning the timing and extent of chemotherapy and hepatic resection for colorectal metastases.
O'Rourke
T R
TR
Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Foundation Trust, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, United Kingdom.
Welsh
F K S
FK
Tekkis
P P
PP
Lyle
N
N
Mustajab
A
A
John
T G
TG
Peppercorn
D
D
Rees
M
M
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D003287:Contrast Media; D003911:Dextrans; D005234:Fatty Liver / Q000139:chemically induced / Q000473:pathology; D005260:Female; D052203:Ferrosoferric Oxide; D006498:Hepatectomy; D006801:Humans; D016014:Linear Models; D008107:Liver Diseases / Q000473:pathology*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
D000970:Antineoplastic Agents; D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; C065507:ferumoxides; D052203:Ferrosoferric Oxide