Future remnant liver function estimated by combining liver volumetry on magnetic resonance imaging with total liver function on (99m)Tc-mebrofenin hepatobiliary scintigraphy: can this tool predict post-hepatectomy liver failure?
Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate and is likely to happen in insufficient liver remnant. We hypothesize that assessment of the estimated future liver remnant function (eFLRF), combining future remnant liver volume (FLRV) with total liver function (TLF), is an accurate formula for prediction of PHLF.



88 patients undergoing hepatectomy were included. The ratio of the future liver remnant volume (FLRV%) was measured on MRI. TLF was estimated by liver clearance of (99m)Technetium (Tc)-mebrofenin on hepatobiliary scintigraphy (HBS). eFLRF was calculated by multiplying FLRV% by TLF. Cut-off values of FLRV% and eFLRF predicting PHLF, were defined by receiver-operating-characteristic (ROC) analysis.



PHLF occurred in 12 patients (13%). Perioperative mortality was 5/12 (41%). Multivariate analysis showed that FLRV% cut off at 40% was not an independent predictive factor. eFLRF cut off at 2.3%/min/m(2) was the only independent predictive factor for PHLF. For FLRV% vs. eFLRF, positive predictive value was 41% vs. 92% and Odds Ratio 26 vs. 836.



FRLF measured by combining FLRV% and TLF is a more valuable tool to predict PHLF than FLRV% alone. The cutoff of eFLRF can be used in clinical decision making.
Hepatobiliary, Endocrine and Transplantation Surgery, University Hospital Antwerp, University Antwerp, Belgium. Electronic address: thiery.chapelle@uza.be.
Thiery
T
Chapelle
Radiology, University Hospital Antwerp, University Antwerp, Belgium.
Bart
B
Op De Beeck
Nuclear Medicine, University Hospital Antwerp, University Antwerp, Belgium.
Ivan
I
Huyghe
Hepatology, University Hospital Antwerp, University Antwerp, Belgium.
Sven
S
Francque
Pathology, University Hospital Antwerp, University Antwerp, Belgium.
Ann
A
Driessen
Hepatobiliary, Endocrine and Transplantation Surgery, University Hospital Antwerp, University Antwerp, Belgium.
Geert
G
Roeyen
Hepatobiliary, Endocrine and Transplantation Surgery, University Hospital Antwerp, University Antwerp, Belgium.
Dirk
D
Ysebaert
Hepatobiliary, Endocrine and Transplantation Surgery, University Hospital Antwerp, University Antwerp, Belgium.
Kathleen
K
De Greef
D000368:Aged; D000814:Aniline Compounds; D019540:Area Under Curve; D005260:Female; D005998:Glycine; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007098:Imino Acids / Q000008:administration & dosage*; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008111:Liver Function Tests / Q000379:methods*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009929:Organ Size; D015609:Organotechnetium Compounds / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012307:Risk Factors; D016896:Treatment Outcome
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine