Abstract
Purpose: To assess the performance of T1 mapping and residual liver volume (RLV) on Gd-EOBDTPA-enhanced MRI in pretreatment estimation of liver function in patients with liver tumors. Indocyanine green retention rate at 15 min (ICG R-15) was used as a reference standard.Methods: Ethical approval from the institutional review board and informed consent were obtained for this prospective study. We enrolled 155 patients with liver tumors who underwent pretreatment Gd-EOB-DTPA-enhanced MRI. T1 relaxation time before (T1-pre), 20 min after (T1-post) Gd-EOB-DTPA injection and RLV were measured. The absolute reduction (ΔT1) and reduction rate (ΔT1%) of T1 relaxation time, volume-assisted ΔT1 (ΔT1*RLV) and volume-assisted ΔT1% (ΔT1%*RLV) were calculated accordingly. The correlation of MR parameters with ICG R-15 was determined using Spearman's rank correlation analysis. Patients were classified into the normal liver function (NLF) group if their ICG R-15 levels were <10% or otherwise into the abnormal liver function (ALF) group. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performances of the MR parameters in predicting ALF.Results: T1-post (r = 0.472, P < 0.001), ΔT1 (r = −0.355, P = 0.011), ΔT1% (r = −0.482, P < 0.001), RLV (r = −0.336, P < 0.001), volume-assisted ΔT1 (r = −0.458, P < 0.001) and volume-assisted ΔT1% (r = −0.522, P < 0.001) showed weak to moderate correlation with ICG R-15. The area under the ROC curves (AUROC) of volume-assisted ΔT1 in predicting ALF was 0.777, which was significantly higher than the other parameters (P < 0.05 for all).Conclusions: Combined T1 mapping and RLV on Gd-EOB-DTPA-enhanced MRI can help assess liver function with good diagnostic accuracy in patients with liver tumors before treatment.
Highlights
Despite technical advances in locoregional treatments including radiofrequency ablation (RFA) and transarterial chemoembolization (TACE), liver resection (LR) remains the most effective treatment for liver tumors at present [1]
Patients were classified into the normal liver function (NLF) group if their indocyanine green (ICG) R-15 levels were
The area under the Receiver operating characteristic (ROC) curves (AUROC) of volume-assisted absolute reduction of T1 relaxation time (T1) in predicting ALF was 0.777, which was significantly higher than the other parameters (P < 0.05 for all)
Summary
Despite technical advances in locoregional treatments including radiofrequency ablation (RFA) and transarterial chemoembolization (TACE), liver resection (LR) remains the most effective treatment for liver tumors at present [1]. Liver failure can occur after RFA and TACE, in patients with large tumors or limited hepatic function reservoirs [4]. Several studies have reported that ICG retention rate at 15 min (ICG R-15) is effective for the pretreatment evaluation of the hepatic functional reserve and can serve as a significant predictor of postoperative liver failure and mortality [9]. These clinical scores and ICG test may provide information regarding global liver function rather than regional deterioration of liver function
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