Abstract
ObjectivesEffective and non-invasive biomarkers to predict and avoid posthepatectomy liver failure (PHLF) are urgently needed. This systematic review aims to evaluate the efficacy of gadoxetic acid–enhanced MRI-derived parameters as an imaging biomarker in preoperative prediction of PHLF.MethodsA systematic literature search was performed in the databases of PubMed/Medline, Web of Science, Embase, and Cochrane Library up to 11 December 2020. Studies evaluating the incidence of PHLF on patients who underwent hepatectomy with preoperative liver function assessment using gadoxetic acid–enhanced MRI were included. Data was extracted using pre-designed tables. The Quality In Prognostic Studies (QUIPS) tool was adopted to evaluate the risk of bias.ResultsA total of 15 studies were identified for qualitative synthesis and most studies were marked as low to moderate risk of bias in each domain of QUIPS. The most commonly used parameter was relative liver enhancement or its related parameters. The reported incidence of PHLF ranged from 3.9 to 40%. The predictive sensitivity and specificity of gadoxetic acid–enhanced MRI parameters varied from 75 to 100% and from 54 to 93% in ten reported studies. A majority of the studies revealed that the gadoxetic acid–enhanced MRI parameter was a predictor for PHLF.ConclusionsGadoxetic acid–enhanced MRI showed a high predictive capacity for PHLF and represents a promising imaging biomarker in prediction of PHLF. Multicenter, prospective trials with large sample size and reliable, unified liver function parameters are required to validate the efficacy of individual liver function parameters.Key Points• There is an obvious heterogeneity of the published studies, not only in variance of MRI liver function parameters but also in indication and extent of the liver resection.• Signal intensity (SI)–based parameters derived from gadoxetic acid–enhanced MRI are the commonly used method for PHLF prediction.• Gadoxetic acid–enhanced MRI-derived parameters showed high predictive efficacy for PHLF and can potentially serve as a predictor for the incidence of PHLF.
Highlights
Posthepatectomy liver failure (PHLF) remains the leading cause of perioperative morbidity and mortality [1]
In order to evaluate liver function, there are several commonly used tests or scoring models, such as the blood biochemical tests, the indocyanine green (ICG) retention test, the LiMAx® test, Child–Pugh score, and the Model for Endstage Liver Disease (MELD) score. Those only give information on certain specific aspects of liver function or on global liver function [4]. Their value and application in the prediction of PHLF are hampered by the fact that they do not consider the heterogeneous distribution of liver function among different liver segments, which is significant in patients with fibrosis/cirrhosis or after chemotherapy [5]
Out of a total of 114 studies found in the systematic literature search, 15 studies using gadoxetic acid–enhanced MRI-derived parameters to predict PHLF were considered eligible (Fig. 1)
Summary
Posthepatectomy liver failure (PHLF) remains the leading cause of perioperative morbidity and mortality [1]. In order to evaluate liver function, there are several commonly used tests or scoring models, such as the blood biochemical tests, the indocyanine green (ICG) retention test, the LiMAx® test, Child–Pugh score, and the Model for Endstage Liver Disease (MELD) score. Those only give information on certain specific aspects of liver function or on global liver function [4]. Their value and application in the prediction of PHLF are hampered by the fact that they do not consider the heterogeneous distribution of liver function among different liver segments, which is significant in patients with fibrosis/cirrhosis or after chemotherapy [5]. Regional liver function information can be provided by hepatobiliary scintigraphy, its wide utilization is mainly limited by its low spatial resolution [6]
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