title: Liver steatosis assessed by preoperative MRI: An independent risk factor for severe complications after major hepatic resection.
abstract: BACKGROUND
  Steatosis assessed by histology is commonly considered to be a significant risk factor for liver surgery. MRI is considered as the new gold standard for noninvasive liver fat quantification. The purpose was to assess whether liver steatosis determined by preoperative MRI is an independent risk factor of complications after major liver resection.
  
  
  METHODS
  All patients who underwent liver MRI before major liver resection in our institution between January 2001 and December 2011 were included in this retrospective study. The liver fat fraction (LFF) was assessed on in- and opposed-phase T1-weighted dual echo gradient echo MRI and steatosis was defined as a MRI LFF of ≥ 5%. The association between steatosis and postoperative complications (Clavien-Dindo classification, ascites > 500 mL at day 5, 50-50 criteria, fistula/collection, blood liver test alterations, pulmonary complications, nonpulmonary complications, >1 complication, duration of stay in the intensive care unit, duration of hospital stay, and death) was assessed by multivariate analysis using the appropriate model.
  
  
  RESULTS
  A MRI LFF of ≥ 5% was associated with severe postoperative complications (Clavien-Dindo score ≥ IIIa; P = .04), more pulmonary complications (P = .02), and longer duration of hospital stay (P = .02) on the multivariate model adjusted for confounding factors. The postoperative aminotransferase levels were higher in patients with a MRI LFF of ≥ 5%, than in other patients (P = .0008).
  
  
  CONCLUSIONS
  Liver steatosis assessed by routine preoperative MRI is shown to be an independent risk factor of severe postoperative complications after major liver resection.
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Gaspard
authors.initials: G
authors.lastname: d'Assignies
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Cindy
authors.initials: C
authors.lastname: Fayard
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Helena
authors.initials: H
authors.lastname: Leitao
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, APHP, University Hospitals Paris Nord Val de Seine, Bichat, Paris, France; INSERM CIC 1425-EC, UMR 1123 ECEVE, Paris, France.
authors.forename: Toni
authors.initials: T
authors.lastname: Alfaiate
authors.affiliation: University Paris Diderot, Sorbonne Paris Cité, Paris, France; Département d'Epidémiologie et Recherche Clinique, APHP, University Hospitals Paris Nord Val de Seine, Bichat, Paris, France; INSERM CIC 1425-EC, UMR 1123 ECEVE, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.affiliation: Department of Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France; Department of Pathology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Bernard E
authors.initials: BE
authors.lastname: Van Beers
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. Electronic address: maxime.ronot@bjn.aphp.fr.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index