Abstract
This study aimed to monitor the course of liver regeneration by multiparametric magnetic-resonance imaging (MRI) after partial liver resection characterizing Small-for-Size Syndrome (SFSS), which frequently leads to fatal post-hepatectomy liver failure (PLF).Twenty-two C57BL/6 mice underwent either conventional 70% partial hepatectomy (cPH), extended 86% partial hepatectomy (ePH) or SHAM operation. Subsequent MRI scans on days 0, 1, 2, 3, 5 and 7 in a 4.7T MR Scanner quantified longitudinal and transverse relaxation times, apparent diffusion coefficient (ADC) and the magnetization-transfer ratio (MTR) of the regenerating liver parenchyma. Histological examination was performed by hematoxylin-eosin staining. After hepatectomy, an increase of T1 time was detected being larger for ePH on day 1: 18% for cPH vs. 40% for ePH and on day 2: 24% for cPH vs. 49% for ePH. An increase in T2 time, again greater in ePH was most pronounced on day 5: 21% for cPH vs. 41% for ePH. ADC and MTR showed a decrease on day 1: 21% for ePH vs. 13% for cPH for ADC, 15% for ePH vs. 11% for cPH for MTR. Subsequently, all MR parameters converged towards initial values in surviving animals. Dying PLF animals exhibited the strongest increase of T1 relaxation time and most prominent decreases of ADC and MTR. The retrieved MRI biomarkers indicate SFSS and potentially developing PLF at an early stage, likely reflecting cellular hypertrophy with extended water content and concomitantly diluted cellular components as features of liver regeneration, appearing more intense in ePH as compared to cPH.
Highlights
Liver resection is often the only chance of cure in patients with liver malignancies such as hepatocellular carcinoma or colorectal liver metastases [1]
One cohort of mice was dedicated to magneticresonance imaging (MRI) assessment after conventional 70% partial hepatectomy (cPH), extended 86% partial hepatectomy (ePH) or SHAM operation in a longitudinal study, the other cohort, requiring tissue harvest for histological examination of the liver parenchyma was examined in a cross-sectional study after cPH, ePH or SHAM operation, providing essentially the histology of liver regeneration corresponding to each time point of the MRI investigation
Extended hepatectomy is associated to cellular hypertrophy and lipid accumulation On representative H&E stains of paraffin embedded tissue sections, there are notable morphological alterations over the time course of liver regeneration, and within the two study groups, cPH and ePH on postoperative day (POD) 1, 2, 3, and 5 (Fig 3)
Summary
Liver resection is often the only chance of cure in patients with liver malignancies such as hepatocellular carcinoma or colorectal liver metastases [1]. Techniques of liver resection, termed as partial hepatectomy (PH), have been significantly refined with an increasing number of patients being amenable to curative resection [2]. In case of extended PH (>70% resected liver volume) patients may develop postoperative, often fatal complications such as post-hepatectomy liver failure (PLF) due to insufficient volume or insufficient function of the remnant liver, known as small for size syndrome (SFSS). The prospect of liver recovery after PH is difficult to judge and the currently applied prognostic criteria diagnosing SFSS and predicting its exacerbation towards PLF are mainly based on different grades of hepatic encephalopathy and on blood parameters such as prolonged prothrombin time, hyperbilirubinemia and hypoalbuminemia determined on consecutive postoperative days (PODs) [1, 3]
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