Korean J Radiol.  2015 Jun;16(3):523-530. 10.3348/kjr.2015.16.3.523.

Preoperative Estimation of Future Remnant Liver Function Following Portal Vein Embolization Using Relative Enhancement on Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging

• Sato Y
• Matsushima S
• Inaba Y
• Sano T
• Yamaura H
• Kato M
• Shimizu Y
• Senda Y
• Ishiguchi

• KMID: 2155521
• DOI: http://doi.org/10.3348/kjr.2015.16.3.523

Abstract

OBJECTIVE
To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE).
MATERIALS AND METHODS
In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE.
RESULTS
Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023).
CONCLUSION
Relative enhancement imaging can be used to estimate FRL function after PVE.

Keyword

Future remnant liver function; Gd-EOB-DTPA-enhanced MR imaging; Portal vein embolization

MeSH Terms

Adult
Aged
Aged, 80 and over
Embolization, Therapeutic/*methods
Female
*Gadolinium DTPA
Hepatectomy/methods
Humans
Indocyanine Green/pharmacokinetics
Liver/*pathology/surgery
Liver Neoplasms/*surgery
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Portal Vein/pathology
Regression Analysis
Retrospective Studies
Treatment Outcome
Gadolinium DTPA
Indocyanine Green

Figure

• 

  Fig. 1 Flow chart of patients who were included in study.

• 

  Fig. 2 Magnetic resonance imaging in patient with biliary cancer.A, B. Relative enhancement (RE) images, before (A) and after (B) portal vein embolization (PVE). RE of embolized lobe decreased after PVE. This patient underwent right trisectionectomy. C. Defined regions of interest (ROIs) for remnant liver parenchyma without major vessels in hepatobiliary phase image after PVE.

• 

  Fig. 3 Correlation between indocyanine green clearance (ICG-K) and relative enhancement (RE) imaging (n = 53).A. ICG-K correlated with RE Index in total liver evaluation (r = 0.365, p = 0.007). B. ICG-K of future remnant liver (ICG-Krem) strongly correlated with future remnant liver (Rem) RE Index (r = 0.738, p < 0.001).

• 

  Fig. 4 Correlation between indocyanine green clearance of future remnant liver (ICG-Krem) and future remnant liver relative enhancement index (Rem RE Index) after portal vein embolization (n = 23).ICG-Krem significantly correlated with Rem RE Index (r = 0.508, p = 0.013).

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