Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study.
Liver fibrosis determines the functional liver reserve. Several studies have reported that the apparent diffusion coefficient (ADC) values of diffusion-weighted magnetic resonance imaging (DW-MRI) can assess liver fibrosis. We investigated whether DW-MRI predicts postoperative hepatic insufficiency and liver fibrosis in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Twenty-six patients with HBV-related HCC who received preoperative DW-MRI on a 3-T MRI system were enrolled between July and December 2008. ADC values were measured twice by two observers. Three "b values" were used: 50, 400 and 800 s/mm(2). Postoperative hepatic insufficiency was defined as persistent hyperbilirubinemia (total bilirubin level >5 mg/dl for more than 5 days after surgery) or postoperative death without other causes. The mean age (21 men and 5 women) was 51.4 years. Three patients experienced postoperative hepatic insufficiency. liver stiffness measurement predicted postoperative hepatic insufficiency, advanced fibrosis (F3-4), and cirrhosis significantly [area under the receiving operator characteristic curve (AUROC)=0.942, 0.771 and 0.818, respectively, with P=.047, 0.048 and 0.006, respectively]; ADC values of DW-MRI, however, did not (AUROC=0.797, 0.648 and 0.491, respectively, with P=.100, 0.313 and 0.938, respectively). Reliability of ADC values between right and left hepatic lobes (rho=0.868 and rho=0.910 in the first and second measures of Observer A; rho=0.865 and rho=0.831 in the first and second measures of Observer B) was high and the intra- and interobserver reliability (rho=0.958 in observer A and rho=0.977 in observer B; rho=0.929 in the first measure and rho=0.978 in the second measure between the two observers) were high. All reliability was significant (P<.001). Our results suggest that DW-MRI on a 3-T MRI system is not suitable for predicting postoperative hepatic insufficiency, advanced liver fibrosis, and cirrhosis in patients with HBV-related HCC, despite significantly high reliability.
Kim
Seung Up
SU
Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
Kim
Young Chul
YC
Choi
Ji Soo
JS
Kim
Kyung Sik
KS
Choi
Gi Hong
GH
Choi
Jin Sub
JS
Park
Jun Yong
JY
Kim
Do Young
DY
Ahn
Sang Hoon
SH
Choi
Eun Hee
EH
Park
Young Nyun
YN
Chon
Chae Yoon
CY
Han
Kwang-Hyub
KH
Kim
Myeong-Jin
MJ
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery* / Q000821:virology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D048550:Hepatic Insufficiency / Q000175:diagnosis*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications / Q000175:diagnosis; D008099:Liver / Q000473:pathology / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D016019:Survival Analysis