title: Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Kim
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Choi
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Choi
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
mesh_terms: 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