The Value Of Preoperative Gd-eob-dtpa Enhanced Mr In Evaluating Liver Reserve Function

Objective The purpose of this study was to evaluate Gd-EOB-DTPA enhanced MR combined with liver volume measurement for evaluating liver reserve function before operation and predicting residual liver function after operation,and try to combine them to obtain a better evaluation method of liver reserve function.Methods From July 2018 to September 2019,93 cirrhotic patients with focal liver lesions diagnosed in our hospital and scheduled for surgical treatment were prospectively collected.All patients underwent Gd-EOB-DTPA enhanced MR scanning and indocyanine green?ICG?test before operation.54 patients?34 men and 20 women?were finally enrolled in this study according to the inclusion criteria and exclusion criteria.Hisense computer-assisted surgery system was used to measure the preoperative liver volume?LV?.PACS system was used to measure the signal intensity of hepatic parenchyma on plain scan and hepatobiliary phase.Siemens MapIT post-processing software was used to measuer the T₁ relaxation time of liver parenchyma on plain scan and hepatobiliary phase.Then?T₁,FV,RE,RE×LV were calculated.The functional parameters were calculated as follows:?T₁=?T₁pre-T₁pos?/T₁pre,FV=LV×?T₁,RE=?SIpos-SIpre?/SIpre,RE×LV.Hisense computer-assisted surgery system was used to simulate hepatectomy,then residual liver volume?rLV?was measured after simulated operation.The simulated-operative residual functional parameters were measured and calculated as follows:rFV=?T₁×rLV,RE×rLV.All patients underwent Child-Pugh score one week after liver operation.44 patients were Child-Pugh A group and 10 patients were Child-Pugh B group.Spearman correlation test was used to analyze the correlation between preoperative liver volume?functional parameters??T₁,FV,RE,RE×LV?and 15min retention rate of indocyanine green?ICG-R15?.Spearman correlation test was used to analyze the correlation between simulated-operative residual liver volume?residual functional parameters?rFV,RE×rLV?and ICG-R15.One-way ANOVA was used to compare the differences of all functional parameters between Child-Pugh A group and Child-Pugh B group.ROC curve was performed to to differentiate between Child-Pugh A group and Child-Pugh B group,and the diagnostic efficiency and the optimum critical value was calculated.P values<?0.05 were considered to indicate statistically significant difference.Results There was no significant correlation between ICG-R15 and LV?P>0.05?.ICG-R15 was negatively correlated with?T₁,FV,RE,RE×LV?r=-0.516?-0.543?-0.465?-0.488;P<?0.05?.There was no significant correlation between ICG-R15 and rLV?P>0.05?.ICG-R15 was negatively correlated with rFV,RE×rLV?r=-0.558?-0.497;P<?0.05?,among which rFV had the highest correlation.The differences between?T₁,FV and rFV among Child-Pugh A group and Child-Pugh B group were statistically significant?P<0.05?.There was no significant difference in LV,rLV,RE,RE×LV and RE×rLV between Child-Pugh A group and Child-Pugh B group?P>0.05?.The area under the curve of Child-Pugh A group and Child-Pugh B group identified by?T₁,FV,rFV was 0.710?0.734?0.743 respectively?P>0.05?,and the cut-off values were 0.175?368.94?332.835 respectively.Conclusions Preoperative liver Gd-EOB-DTPA enhanced MR functional parameters and simulated-operative residual functional parameters can be used to predict and quantitatively evaluate liver reserve function.The values of?T₁,FV and rFV can be used to predict the residual liver function,FV and rFV had higher diagnostic efficiency.