Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure.

IF 8.6 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2025-04-30 DOI:10.1093/bjs/znaf103

Wolf C Bartholomä, Stefan Gilg, Peter Lundberg, Peter N Larsen, Ville Sallinen, Malin Sternby Eilard, Jozef Urdzik, Gert Lindell, Torkel B Brismar, Eva Fallentin, Ali Ovissi, Andreas Socratous, Tomas Bjerner, Sophie Kollbeck, Jens Tellman, Fredrik Holmquist, Nils Dahlström, Mischa Woisetschläger, Bergthor Björnsson, Ernesto Sparrelid, Per Sandström

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引用次数: 0

Abstract

Background: Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF.

Methods: This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C).

Results: Among the 292 patients, 25 (8.6%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P < 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803).

Conclusion: The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.

查看原文本刊更多论文

磁共振衍生的肝脏摄取指数提高了对肝切除术后严重肝衰竭风险患者的识别。

背景：肝切除术后肝功能衰竭（PHLF）是肝切除术后死亡的主要原因。准确的术前风险评估是必不可少的，但目前的方法有局限性。Gadoxetic酸增强MRI （Gd-EOB MRI）可以对肝脏进行形态学和功能评估。本研究的目的是评估术前常规Gd-EOB MRI获得的肝摄取指数（HUI）在识别严重PHLF风险患者中的作用。方法：这项观察性、回顾性的多中心研究纳入了瑞典、丹麦和芬兰2010年至2020年间接受肝切除术的292例患者。术前对每位患者进行Gd-EOB MRI检查，并评估HUI、标准化未来肝残体肝摄取指数（sFLR-HUI）和终末期肝病模型3 （MELD 3）评分。统计分析包括logistic回归和受试者工作特征（ROC）曲线评估，以确定严重PHLF的临界值和判别精度（国际肝脏外科研究组分级B和C）。结果：292例患者中，25例（8.6%）发展为重度PHLF。重度PHLF患者的HUI值和sFLR-HUI值显著降低（P < 0.001）。HUI在严重PHLF（曲线下面积（AUC） 0.758）方面的鉴别性能优于单纯的体积评估，如标准化未来肝残余（sFLR）（AUC 0.628）。将HUI与MELD 3评分相结合进一步提高了性能（AUC为0.803）。结论：常规Gd-EOB MRI获得的HUI在识别严重PHLF风险患者方面优于基于体积的生物标志物（sFLR）。将图像衍生的功能评估（如HUI）与独立的生物标志物（如MELD 3评分）结合起来，可能会优化严重PHLF的术前风险分层，并改善大肝切除术后的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.