Assessing The Risk Of Liver Failure After Major Liver Resection By Gd-EOB-DTPA Enhan-ced MRI

Objective: Post hepatectomy liver failure is one of the most serious complications after hepatectomy and also the leading cause of death after liver resection.Therefore,it is very important to make accurate calculation of residual liver reserve function before operation.At present,the clinical routine assessment methods of liver function include liver function serum biochemical index,Child-Pugh score system,indocyanine green clearance test,imaging liver volume measurement,etc.However,these methods evaluate the liver function of liver segment Not accurate enough.In order to prevent the risk of liver failure after liver resection,it is urgent to find a method that can accurately evaluate the liver function in different sections of the liver in order to meet the requirement of preoperative accurate assessment of postoperative residual liver function.Gd-EOB-DTPA(gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid)is a contrast-enhancing agent with dual characteristics of hepatocyte-specific uptake and extrahepatic gap imaging.It can quantitatively assess the function of hepatocytes in different sections.This study was based on the calculation of liver cell uptake of gadoxate disodium and liver volume to investigate the effect of Gd-EOB-DTPA-enhanced MRI in assessing the risk of liver failure after extensive liver resection.Methods : Thirty-six patients with three or more stages of hepatectomy were enrolled in Chengdu Military General Hospital from September 2016 to September 2017.All patients underwent Gd-EOB-DTPA enhanced MRI and liver CT examination within 4 weeks before operation,Liver function index and ICG clearance test were completed within 1 week before operation,and the preoperative Child-Pugh score was calculated according to the patient’s disease status and serological test results.According to the patient preoperative related indicators to assess whether the patient underwent surgical treatment,the scope of surgical resection,"Consensus on evaluation of hepatic function reserve before Hepatectomy "(2011 edition),the final surgical plan depending on the specific circumstances of the adjustment.All patients underwent surgical treatment of open surgery,according to the patient’s intraoperative decision whether to perform the first hepatic obstruction,if the need to take the first hepatic obstruction then use the Pringer method.Serum INR and total bilirubin values were measured 5 days postoperatively or afterwards and patients were assessed for the risk of liver failure after hepatectomy according to the appropriate guidelines of the ISGLS(International Study Group Of Liver Surgery 2011).Quantitative analysis of Gd-EOB-DTPA enhanced magnetic resonance imaging in the liver and spleen stratified selection of regions of interest(ROI),calculate the different sections of the liver and residual liver in the Gd-EOB-DTPA enhanced MRI hepatobiliary-specific Single Intensity(SI).Simultaneous calculation of mean signal intensities of hepatobiliary-specific spleen.Using the preoperative 320 T enhanced CT images of the patients,the volume of each liver segment was calculated by Myrian computerized three-dimensional liver surgery planning system,and the residual liver volume was further calculated.According to the calculation formula of hepatocellular uptake index(HUI),HUI = V [(L 20 / S 20)-1],combined with Gd-EOB-DTPA enhances the liver and spleen’s signal intensity and operation The first 320 T enhanced CT computerized three-dimensional imaging of the resulting liver volume,which can be calculated HUI.Residual liver cell uptake rate(r HUI)and standard residual liver cell uptake rate(Sr HUI)were calculated by using Gd-EOB-DTPA to enhance MRI average signal intensity of hepatic biliary tract specific liver,residual liver volume and standard residual liver volume.Preoperative serum liver function indicators(ALT,AST,GGT,ALP,T-bil,Alb,PT,PLT,Cre,PA),Child-Pugh score,residual liver volume,standard residual liver volume,residual liver cell uptake rate,The standard residual liver cell uptake rate and intraoperative blood loss,the difference between the operation time and postoperative risk of liver failure were statistically significant,and the correlation.And the receiver operating characteristic curve(ROC)was used to evaluate the predictive value of r HUI and Sr HUI for the risk of liver failure.Results: In the study,we found that patients with cirrhosis and non-cirrhosis liver Gd-EOB-DTPA enhanced MRI signal intensity there is a significant difference,liver cirrhosis Gd-EOB-DTPA enhanced MRI signal intensity was heterogeneous distribution.There were 8 patients(22.22%)with postoperative risk of liver failure,6 patients(75%)with grade A,2 patients with grade B(25%)and 0 patients with grade C without any death.One patient developed massive postoperative bleeding that was not included in the statistics.In order to verify the preoperative surgical planning residual liver volume consistent with the actual postoperative residual liver volume,we did a preoperative surgical planning of hepatic resection volume and postoperative "drainage method" to measure the volume of liver resection.The result of CT liver volume measurement and drainage is no significant difference in the measurement of liver volume(P> 0.05).There were significant differences in r HUI,Sr HUI and albumin between postoperative risk of liver failure and those without risk of liver failure(P = 0.004,P = 0.002,P = 0.048).Correlation analysis of r HUI,Sr HUI and albumin in postoperative risk group of liver failure and risk of non-liver failure showed that there was a significant correlation between postoperative risk of liver failure and non-risk of liver failure r =-0.482,P =0.03;r =-0.528,P = 0.001;r =-0.335,P = 0.046).There was no significant difference in other indicators in this study.The area under the ROC curve for r HUI and postoperative risk of liver failure was 0.835(sensitivity 71.4%,specificity 87.5%,critical value 0.614,95% confidence interval 0.692,0.978);The area under the ROC curve(AUC)for Sr HUI and postoperative risk of liver failure was 0.864(sensitivity 85.7%,specificity 75.0%,cutoff 0.344,95% confidence interval 0.730,0.998).Conlusion HUI is a good indicator to evaluate the function of liver cells and liver volume in assessing liver reserve function in patients with liver cirrhosis. Gd-EOB-DTPA enhanced MRI can quantitatively assess the local liver reserve function.Combined with Gd-EOB-DTPA hepatocyte uptake rate and remnant liver volume measurement can be more accurate assessment of remnant liver function volume,is of great significance in predicting the risk of liver failure after a wide range of hepatectomy.