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Purpose <p>Significant advances have been made in image-based determinations of future remnant liver function, in attempts to better predict post-hepatectomy liver failure (PHLF). We have reported time-associated liver functional assessments using magnetic resonance imaging with liver-to-spleen signal intensity ratio increasing rate (LSRi) and LSRi of the future remnant liver region (LSRi-rem) to predict PHLF. This study aimed to investigate the predictability of PHLF by a preoperative liver function assessment index that combined LSRi-rem and future remnant liver volume (FRLV).</p> Methods <p>Participants comprised 333 patients who underwent EOB-MRI for the diagnosis of liver tumor before major hepatectomy between 2009 and 2024. LSRi-rem was evaluated by three-dimensional volumetric analysis, and the volume adjusted LSRi-rem (vaLSRi-rem) was calculated using the following formula: LSRi-rem × (FRLV / whole-liver volume). The vaLSRi-rem and clinical variables were then analyzed to assess the risk of PHLF.</p> Results <p>In patients with vaLSRi-rem &lt; 0.147, right hepatectomy, operation time ≥ 400&#xa0;min, and estimated blood loss ≥ 1495 mL were associated with clinically relevant PHLF (<i>P</i> &lt; 0.05 each) in multivariable analysis. Multivariable analysis showed the highest odds ratio (OR) for vaLSRi-rem (OR 9.12; <i>P</i> &lt; 0.01). Of the 333 patients, 114 (34%) underwent portal vein embolization before major hepatectomy. The OR of vaLSRi-rem from multivariable analysis in this patient cohort was particularly high (OR 21.04; <i>P</i> &lt; 0.01).</p> Conclusions <p>Strong associations were identified between vaLSRi-rem and clinically relevant PHLF after major hepatectomy, particularly among portal vein embolization patients.</p>

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Predicting post-hepatectomy liver failure based on future remnant liver function combined with future remnant liver volume using magnetic resonance imaging

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月6日

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  • Masashi Kudo,
  • Naoto Gotohda,
  • Motokazu Sugimoto,
  • Shin Kobayashi,
  • Tatsushi Kobayashi

摘要

Purpose

Significant advances have been made in image-based determinations of future remnant liver function, in attempts to better predict post-hepatectomy liver failure (PHLF). We have reported time-associated liver functional assessments using magnetic resonance imaging with liver-to-spleen signal intensity ratio increasing rate (LSRi) and LSRi of the future remnant liver region (LSRi-rem) to predict PHLF. This study aimed to investigate the predictability of PHLF by a preoperative liver function assessment index that combined LSRi-rem and future remnant liver volume (FRLV).

Methods

Participants comprised 333 patients who underwent EOB-MRI for the diagnosis of liver tumor before major hepatectomy between 2009 and 2024. LSRi-rem was evaluated by three-dimensional volumetric analysis, and the volume adjusted LSRi-rem (vaLSRi-rem) was calculated using the following formula: LSRi-rem × (FRLV / whole-liver volume). The vaLSRi-rem and clinical variables were then analyzed to assess the risk of PHLF.

Results

In patients with vaLSRi-rem < 0.147, right hepatectomy, operation time ≥ 400 min, and estimated blood loss ≥ 1495 mL were associated with clinically relevant PHLF (P < 0.05 each) in multivariable analysis. Multivariable analysis showed the highest odds ratio (OR) for vaLSRi-rem (OR 9.12; P < 0.01). Of the 333 patients, 114 (34%) underwent portal vein embolization before major hepatectomy. The OR of vaLSRi-rem from multivariable analysis in this patient cohort was particularly high (OR 21.04; P < 0.01).

Conclusions

Strong associations were identified between vaLSRi-rem and clinically relevant PHLF after major hepatectomy, particularly among portal vein embolization patients.