Jeong Hee Yoon MD, Presenter: Nothing to Disclose

Jeong Min Lee MD, Abstract Co-Author: Research Grant, Guerbet SA Equipment support, Siemens AG Research Grant, Bayer AG

So Yeon Kim MD, Abstract Co-Author: Nothing to Disclose

Joon Il Choi MD, PhD, Abstract Co-Author: Nothing to Disclose

Yong-Yeon Jeong MD, Abstract Co-Author: Nothing to Disclose

Andrea Schenk PhD, Abstract Co-Author: Nothing to Disclose

Longquan Chen MSc, Abstract Co-Author: Nothing to Disclose

Hendrik Oliver Arp Laue PhD, Abstract Co-Author: Nothing to Disclose

To determine whether predicted remnant liver function (RLF) on dynamic hepatcyte-specific contrast-enhanced (DHCE)-MRI using Gd-EOB-DTPA correlates with standard liver function(LF) test results (ICG R15) after resection or radiofrequency ablation (RFA).

 This prospective study approved by IRB and informed consent was obtained in all patients. Fifty-five patients with hepatocellular carcinomas who underwent resection (n=50), RFA (n=2), or liver transplantation (n=3), and nine living liver donors were enrolled. All underwent DHCE-MRI and ICG R15 tests within 7 days ahead of treatment. Fifty-one patients underwent follow-up either DHCE- (n=36) or noncontrast (n=15) MRI on post-treatment day 3. Hepatic extraction fraction [HEF] and HEF multiplied by liver volume [HEFmL] were calculated using deconvolution analysis. The predicted HEF and HEFmL were compared with post-treatment ICG R15 to predict RLF. In addition, pre- and post-treatment HEF and HEFmL were compared to pre-and post-treatment ICG R15. Furthermore, critical LF was calculated using HEFmL to predict ICG R15≥20%. Last, intra-individual heterogeneity of HEF was assessed using coefficients of variation (CV) among the hepatic segments.

Predicted HEF and HEFmL obtained from pre-treatment MR imaging showed a statistically significant correlation with post-treatment ICG R15 (r=-0.37, -0.31, respectively, P <0.05). HEF and HEFmL calculated from pre- and post-treatment MR imaging also showed significant correlations with pre- and post-treatment ICG R15 (r=-0.39 to -0.59, respectively, P<0.05). In predicting ICG R15≥20%, HEFmL showed 73.7% sensitivity and 87.2% specificity with a cut-off value of 118.1mL (AUC: 0.78, P<0.001). In addition, 56.1% (55/98) of DHCE-MRI showed CVs of segmental HEF higher than 10% (10~40%).  Figure 1 (top row). Semiautomatic volumetry (a) followed by automatic vascular segmentation (b) and identification of vascular territories (c). Figure 2. HEF maps of liver donor(a), Child A5 (b), and Child B7 (c). Note the heterogeneous distribution of HEF in each case.

DHCE-MRI provided information of global and segmental LF. In addition, RLF could be predicted using HEFmL which showed a negative correlation with post-treatment ICG R15.

DHCE-MRI may be able to provide global and regional LF, which could be helpful for clinicians in choosing therapeutic strategy for HCC and in planning liver surgery. 

Yoon, J, Lee, J, Kim, S, Choi, J, Jeong, Y, Schenk, A, Chen, L, Laue, H, Pretreatment Evaluation of Future Remnant Liver Function Using Gd-EOB-DTPA enhanced Magnetic Resonance Imaging in Patients Undergoing Hepatic Resection or Radiofrequency Ablation for Hepatocellular Carcinoma.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018697.html