Predicting post-hepatectomy liver failure with T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI: comparison with the indocyanine green clearance test and albumin-bilirubin scoring system.

Objectives: To explore the value of T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI for predicting post-hepatectomy liver failure (PHLF).

Methods: Consecutive patients from March 2016 to March 2018 who underwent gadoxetic acid-enhanced MRI in our hospital were retrospectively analyzed, and 37 patients were enrolled. Whole-liver T1 mapping-based histogram analysis was performed. The indocyanine green (ICG) clearance tests were performed, and albumin-bilirubin (ALBI) scores were calculated. Univariate and multivariate binary logistic analyses were performed to identify independent predictors for PHLF. Diagnostic performance was evaluated with ROC analysis. Histogram-extracted parameters were also associated with the ICG test and ALBI scoring system.

Results: In enrolled 37 patients (age 57.19 ± 12.28 years), 28 were male. 35.1% (13/37) of patients developed PHLF. For univariate analysis, pre-contrast T1 relaxation time (T1pre) mean, T1pre 95th percentile, the standard deviation (SD) of T1 relaxation time in hepatobiliary phase (T1HBP SD), T1HBP 95th percentile, T1HBP kurtosis, and ICG percentage retained at 15 min (ICG-R15) showed significant differences between the PHLF and non-PHLF groups (all p < 0.05), whereas the ALBI scores showed no significant differences between the two groups (p = 0.937). Multivariate analysis showed that a higher T1HBP 95th percentile was the independent predictor for PHLF (p < 0.05; odds ratio (OR) = 1.014). In addition, most of the histogram-extracted parameters showed significant correlations to the ICG test.

Conclusions: T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI is valuable for PHLF prediction and risk stratification, which outperformed the ICG clearance test and ALBI scoring system.

Key points: Question What is the value of T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI for PHLF? Findings The histogram parameters extracted from gadoxetic acid-enhanced T1 mapping manifested potential for grading liver function preoperatively. Clinical relevance T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI can serve as a convenient one-station radiological tool to help identify potential PHLF risks within the preoperative clinical decision-making framework.