title: Liver-fat and liver-function indices derived from Gd-EOB-DTPA-enhanced liver MRI for prediction of future liver remnant growth after portal vein occlusion.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Borna K
authors.initials: BK
authors.lastname: Barth
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.affiliation: Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Patryk
authors.initials: P
authors.lastname: Kambakamba
authors.affiliation: Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
authors.forename: Mickael
authors.initials: M
authors.lastname: Lesurtel
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland. Electronic address: caecilia.reiner@usz.ch.
authors.forename: Caecilia S
authors.initials: CS
authors.lastname: Reiner
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005544:Forecasting; D019786:Gadolinium DTPA; D006498:Hepatectomy / Q000379:methods*; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D007089:Image Enhancement / Q000379:methods*; D008026:Ligation / Q000379:methods; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008107:Liver Diseases / Q000601:surgery; D008115:Liver Regeneration / Q000502:physiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D011183:Postoperative Complications; D012372:ROC Curve; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D055815:Young Adult
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Gadolinium ethoxybenzyl DTPA; Liver; Liver steatosis; Magnetic resonance imaging; Neoplasm metastases