Predicting post‐hepatectomy liver failure by combined volumetric, functional MR image and laboratory analysis

Background & Aims To assess the efficacy of functional MR image with volumetric, liver function test and indocyanine green clearance (ICG) in identifying the patients who are at risk of post‐hepatectomy liver failure (PHLF). Methods We retrospectively included 115 patients undergoing gadoxetic acid‐enhanced MR imaging before hepatectomy at one medical centre from January 2013 to December 2015. Contrast enhancement ratio (CER) between transitional and hepatobiliary phases (3 and 30 minutes post‐contrast) was calculated. Total liver volume (TLV) and spleen volume (Sp) were measured. Post‐operatively, the histological Ishak fibrosis score was collected. Potential risk factors for liver failure were analysed, and the performance was examined by receiver operating characteristic curve. Results Post‐hepatectomy liver failure (PHLF) occurred in 16 patients (13.9%). TLV/SLV, ADC value, CER HBP/TP and total liver contrast enhancement ratio (tCER) were associated with PHLF ( P  < .05). Between PHLF and non‐PHLF groups, remnant liver volume (RLV), RLV/SLV, Sp/RLV, remnant liver contrast enhancement ratio (rCER) and Ishak fibrosis score showed statistical difference. rCER showed superiority in diagnostic performance (AUC = 0.78) with the optimal cut‐off value of 1.23. Conclusions Gadoxetic acid‐enhanced MR imaging with volumetric is a reliable method for evaluating functional liver volume and determining the risk of PHLF.