Abstract
ObjectivesTo compare Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) with 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) as quantitative liver function tests for the preoperative assessment of patients undergoing liver resection.MethodsPatients undergoing liver surgery and preoperative assessment of future remnant liver (FRL) function using 99mTc-mebrofenin HBS were included. Patients underwent DHCE-MRI. Total liver uptake function was calculated for both modalities: mebrofenin uptake rate (MUR) and Ki respectively. The FRL was delineated with both SPECT-CT and MRI to calculate the functional share. Blood samples were taken to assess biochemical liver parameters.ResultsA total of 20 patients were included. The HBS-derived MUR and the DHCE-MRI-derived mean Ki correlated strongly for both total and FRL function (Pearson r = 0.70, p = 0.001 and r = 0.89, p < 0.001 respectively). There was a strong agreement between the functional share determined with both modalities (ICC = 0.944, 95% CI 0.863–0.978, n = 20). There was a significant negative correlation between liver aminotransferases and bilirubin for both MUR and Ki.ConclusionsAssessment of liver function with DHCE-MRI is comparable with that of 99mTc-mebrofenin HBS and has the potential to be combined with diagnostic MRI imaging. This can therefore provide a one-stop-shop modality for the preoperative assessment of patients undergoing liver surgery.Key Points• Quantitative assessment of liver function using hepatobiliary scintigraphy is performed in the preoperative assessment of patients undergoing liver surgery in order to prevent posthepatectomy liver failure.• Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) is an emerging method to quantify liver function and can serve as a potential alternative to hepatobiliary scintigraphy.• Assessment of liver function with dynamic gadoxetate-enhanced MRI is comparable with that of hepatobiliary scintigraphy and has the potential to be combined with diagnostic MRI imaging.
Highlights
Surgical resection remains the only curative treatment in patients with primary and metastatic liver tumors and is presently performed with limited morbidity and mortality [1, 2]
Assessment of liver function with dynamic gadoxetate-enhanced MRI is comparable with that of hepatobiliary scintigraphy and has the potential to be combined with diagnostic MRI imaging
Patients diagnosed with one or more liver lesions and who were scheduled for 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) as part of the preoperative workup were included in this prospective observational pilot study
Summary
Surgical resection remains the only curative treatment in patients with primary and metastatic liver tumors and is presently performed with limited morbidity and mortality [1, 2]. An insufficient future remnant liver (FRL) is one of the most important risk factors for the development of PHLF. Preoperative assessment liver function is crucial in order to minimize the risk of developing PHLF. Several quantitative dynamic liver function tests are currently used to assess hepatic uptake and excretory function. This can be done with hepatobiliary scintigraphy (HBS) using technetium-99m (99mTc)-labeled iminodiacetic acid derivates of which mebrofenin is the most hepatocyte specific [6]. Because HBS provides a direct quantitative measure of the uptake function, it can be used in both patients with healthy or impaired liver parenchyma (e.g., steatosis, hepatitis, and fibrosis) using the same cutoff value for the uptake rate (2.7%/min/m2) [9]. HBS is combined with SPECT-CT which provides information on the regional distribution of liver function, enabling a more anatomical evaluation of FRL function [10]
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