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01-11-2020 | Magnetic Resonance Imaging | Original Article

Efficiency of regional functional liver volume assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein tumor thrombus

Authors: Kenichiro Araki, Norifumi Harimoto, Takahiro Yamanaka, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Norio Kubo, Yoshito Tsushima, Ken Shirabe

Published in: Surgery Today | Issue 11/2020

Abstract

Purpose

We investigated whether functional future remnant liver volume (fFRLV), assessed using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), could evaluate regional liver function in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and help establish the indication for hepatectomy.

Methods

The subjects of this study were 12 patients with PVTT [PVTT(+) group] and 58 patients without PVTT [PVTT(−) group], from among 191 patients who underwent hepatectomy of more than one segment for HCC. We calculated the liver-to-muscle ratio (LMR) in the remnant liver, using EOB-MRI and fFRLV. Preoperative factors and surgical outcome were compared between the groups. The LMR of the area occluded by PVTT was compared with that of the non-occluded area.

Results

The indocyanine green retention rate at 15 min (ICG-R15) and liver fibrosis indices were increased in the PVTT(+) group, but the surgical outcomes of patients in this group were acceptable, with no liver failure, no mortality, and no differences from those in the PVTT(−) group. The fFRLV in the PVTT(+) group was not significantly different from that in the PVTT(−) group (p = 0.663). The LMR was significantly lower in the occluded area than in the non-occluded area (p = 0.004), indicating decreased liver function.

Conclusion

Assessing fFRLV using EOB-MRI could be useful for evaluating regional liver function and establishing operative indications for HCC with PVTT.

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Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–55. https://doi.org/10.1016/s0140-6736(11)61347-0.CrossRefPubMed

Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology. 1999;29:62–7. https://doi.org/10.1002/hep.510290145.CrossRefPubMed

Ikai I, Hatano E, Hasegawa S, Fujii H, Taura K, Uyama N, et al. Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein. J Am Coll Surg. 2006;202:431–8. https://doi.org/10.1016/j.jamcollsurg.2005.11.012.CrossRefPubMed

Ban D, Shimada K, Yamamoto Y, Nara S, Esaki M, Sakamoto Y, et al. Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein. J Gastrointest Surg. 2009;13:1921–8. https://doi.org/10.1007/s11605-009-0998-0.CrossRefPubMed

Matono R, Yoshiya S, Motomura T, Toshima T, Kayashima H, Masuda T, et al. Factors linked to longterm survival of patients with hepatocellular carcinoma accompanied by tumour thrombus in the major portal vein after surgical resection. HPB (Oxford). 2012;14:247–53. https://doi.org/10.1111/j.1477-2574.2011.00436.x.CrossRefPubMedPubMedCentral

Shi J, Lai EC, Li N, Guo WX, Xue J, Lau WY, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol. 2010;17:2073–80. https://doi.org/10.1245/s10434-010-0940-4.CrossRefPubMed

Ye JZ, Wang YY, Bai T, Chen J, Xiang BD, Wu FX, et al. Surgical resection for hepatocellular carcinoma with portal vein tumor thrombus in the Asia-Pacific region beyond the Barcelona Clinic Liver Cancer treatment algorithms: a review and update. Oncotarget. 2017;8:93258–78. https://doi.org/10.18632/oncotarget.18735.CrossRefPubMedPubMedCentral

Nishie A, Ushijima Y, Tajima T, Asayama Y, Ishigami K, Kakihara D, et al. Quantitative analysis of liver function using superparamagnetic iron oxide- and Gd-EOB-DTPA-enhanced MRI: comparison with Technetium-99 m galactosyl serum albumin scintigraphy. Eur J Radiol. 2012;81:1100–4. https://doi.org/10.1016/j.ejrad.2011.02.053.CrossRefPubMed

Tajima T, Takao H, Akai H, Kiryu S, Imamura H, Watanabe Y, et al. Relationship between liver function and liver signal intensity in hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging. J Comput Assist Tomogr. 2010;34:362–6. https://doi.org/10.1097/RCT.0b013e3181cd3304.CrossRefPubMed

10.

Yamada A, Hara T, Li F, Fujinaga Y, Ueda K, Kadoya M, et al. Quantitative evaluation of liver function with use of gadoxetate disodium-enhanced MR imaging. Radiology. 2011;260:727–33. https://doi.org/10.1148/radiol.11100586.CrossRefPubMed

11.

Itoh S, Yoshizumi T, Shirabe K, Kimura K, Okabe H, Harimoto N, et al. Functional remnant liver assessment predicts liver-related morbidity after hepatic resection in patients with hepatocellular carcinoma. Hepatol Res. 2017;47:398–404. https://doi.org/10.1111/hepr.12761.CrossRefPubMed

12.

Araki K, Harimoto N, Kubo N, Watanabe A, Igarashi T, Tsukagoshi M, et al. Functional remnant liver volumetry using Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) predicts post-hepatectomy liver failure in resection of more than one segment. HPB (Oxford). 2020;22:318–27. https://doi.org/10.1016/j.hpb.2019.08.002.CrossRefPubMed

13.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef

14.

Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149:713–24. https://doi.org/10.1016/j.surg.2010.10.001.CrossRefPubMed

15.

Nishie A, Asayama Y, Ishigami K, Tajima T, Kakihara D, Nakayama T, et al. MR prediction of liver fibrosis using a liver-specific contrast agent: superparamagnetic iron oxide versus Gd-EOB-DTPA. J Magn Reson Imaging. 2012;36:664–71. https://doi.org/10.1002/jmri.23691.CrossRefPubMed

16.

Ninomiya M, Shirabe K, Kayashima H, Ikegami T, Nishie A, Harimoto N, et al. Functional assessment of the liver with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetate-enhanced MRI in living-donor liver transplantation. Br J Surg. 2015;102:944–51. https://doi.org/10.1002/bjs.9820.CrossRefPubMed

17.

Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72. https://doi.org/10.1097/01.sla.0000201482.11876.14.CrossRefPubMedPubMedCentral

18.

Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188:304–9.CrossRef

19.

Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85:1058–60. https://doi.org/10.1046/j.1365-2168.1998.00795.x.CrossRefPubMed

20.

Iguchi T, Ikegami T, Fujiyoshi T, Yoshizumi T, Shirabe K, Maehara Y. Low positive airway pressure without positive end-expiratory pressure decreases blood loss during hepatectomy in living liver donors. Dig Surg. 2017;34:192–6. https://doi.org/10.1159/000447755.CrossRefPubMed

21.

Otsubo T, Takasaki K, Yamamoto M, Katsuragawa H, Katagiri S, Yoshitoshi K, et al. Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery. 2004;135:67–73. https://doi.org/10.1016/s0039.CrossRefPubMed

22.

Rahbari NN, Koch M, Zimmermann JB, Elbers H, Bruckner T, Contin P, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg. 2011;253:1102–10. https://doi.org/10.1097/SLA.0b013e318214bee5.CrossRefPubMed

23.

Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg. 1995;169:589–94.CrossRef

24.

Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206. https://doi.org/10.1001/archsurg.138.11.1198(discussion 206).CrossRefPubMed

25.

Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81. https://doi.org/10.1053/jhep.1997.v26.pm0009362359.CrossRefPubMed

26.

Shoup M, Gonen M, D’Angelica M, Jarnagin WR, DeMatteo RP, Schwartz LH, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg. 2003;7:325–30.CrossRef

27.

Kwon AH, Ha-Kawa SK, Uetsuji S, Inoue T, Matsui Y, Kamiyama Y. Preoperative determination of the surgical procedure for hepatectomy using technetium-99 m-galactosyl human serum albumin (99 mTc-GSA) liver scintigraphy. Hepatology. 1997;25:426–9. https://doi.org/10.1002/hep.510250228.CrossRefPubMed

28.

Hayashi H, Beppu T, Okabe H, Kuroki H, Nakagawa S, Imai K, et al. Functional assessment versus conventional volumetric assessment in the prediction of operative outcomes after major hepatectomy. Surgery. 2015;157:20–6. https://doi.org/10.1016/j.surg.2014.06.013.CrossRefPubMed

29.

Utsunomiya T, Shimada M, Hanaoka J, Kanamoto M, Ikemoto T, Morine Y, et al. Possible utility of MRI using Gd-EOB-DTPA for estimating liver functional reserve. J Gastroenterol. 2012;47:470–6. https://doi.org/10.1007/s00535-011-0513-8.CrossRefPubMed

30.

Morine Y, Enkhbold C, Imura S, Ikemoto T, Iwahashi S, Saito YU, et al. Accurate estimation of functional liver volume using Gd-EOB-DTPA MRI compared to MDCT/(99m)Tc-SPECT fusion imaging. Anticancer Res. 2017;37:5693–700. https://doi.org/10.21873/anticanres.12006.CrossRefPubMed

Title: Efficiency of regional functional liver volume assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein tumor thrombus
Authors: Kenichiro Araki
Norifumi Harimoto
Takahiro Yamanaka
Norihiro Ishii
Mariko Tsukagoshi
Takamichi Igarashi
Akira Watanabe
Norio Kubo
Yoshito Tsushima
Ken Shirabe
Publication date: 01-11-2020
Publisher: Springer Singapore
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: Surgery Today / Issue 11/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-020-02062-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Efficiency of regional functional liver volume assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein tumor thrombus

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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