title: Liver failure after hepatectomy: A risk assessment using the pre-hepatectomy shear wave elastography technique.
abstract: OBJECTIVE
  To determine the efficacy of liver stiffness (LS) measurements utilizing the Shear Wave Elastography (SWE) technique for predicting post-hepatectomy liver failure (PHLF) among patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Data from eighty consecutive patients who were undergoing hepatectomy for HCC were prospectively identified and evaluated with preoperative SWE. The SWE was measured with advanced ultrasound equipment (Philips EPIQ7; Philips Healthcare, Seattle, WA, USA). PHLF classification was defined according to the International Study Group of Liver Surgery Recommendations (ISGLS).
  
  
  RESULTS
  SWE was successfully performed in 77 patients. According to the ISGLS criteria, PHLF occurred in 35.1% of patients (27 patients), including 2/25 patients with Grade A/B, respectively. Elevated SWE values (P=0.002) and histological cirrhosis (P=0.003) were independent predictors of PHLF according to the multivariate analysis. Patients with SWE values higher than or equal to 6.9kPa were identified at higher risk of PHLF (area under the curve: 0.843, sensitivity: 77.8% and specificity: 78.0%). Postoperative dynamic course of the median the Model For End-stage Liver Disease (MELD) score showed irregular changes among patients with an SWE >6.9kPa. Patients with an SWE <6.9kPa, postoperative dynamic course of the median MELD score gradually decreased.
  
  
  CONCLUSIONS
  LS measured with SWE is a valid and reliable method for the prediction of PHLF grade A/B among patients with HCC. SWE could become a routine examination for the preoperative evaluation of PHLF.
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. Electronic address: han.hong@zs-hospital.sh.cn.
authors.forename: Hong
authors.initials: H
authors.lastname: Han
authors.affiliation: Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Hu
authors.affiliation: Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
authors.forename: Ya Dan
authors.initials: YD
authors.lastname: Xu
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. Electronic address: puguang61@126.com.
authors.forename: Wen Ping
authors.initials: WP
authors.lastname: Wang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Ding
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D017093:Liver Failure / Q000000981:diagnostic imaging / Q000209:etiology*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Hepatocellular carcinoma; Liver failure; Shear wave elastography