Preoperative Evaluation of Future Remnant Liver Function Using Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma
1. Preoperative assessment of remnant liver function is important for avoiding
posthepatectomy liver failure. However, the function of the future remnant is decreased
in patients with chronic liver disease or cirrhosis, compared to that of healthy
patients with an equal volume. Therefore, volume-based estimation of hepatic reserve
function is inadequate for patients with hepatic dysfunction.
2. Standard clinical liver function tests, such as ICG clearance rate or Child-Pugh score,
provides measurements of the global hepatic function, but cannot evaluate the
functional distribution in the liver. Gd-EOB-DTPA (Gadoxetic acid, Primovist®, Bayer
Schering) enhanced MRI has been recently demonstrated to have the potential to be an
imaging-based liver function test, with the possibility to detect functional
differences on a regional or even segmental level.
3. Gd-EOB-DTPA-enhanced liver MRI may be able to assess not only global but also segmental
liver function in patients with hepatocellular carcinoma (HCC) who have a relatively
high risk for developing liver failure after surgical resection due to coexistent
hepatic damage by chronic viral hepatitis and/or cirrhosis preoperatively.
The purpose of this study is to determine whether the global and segmental hepatic uptake
and excretion of Gd-EOB-DTPA on Gd-EOB-DTPA-enhanced liver MRI correlates with standard
liver function test results in the patients with HCC before major hepatic resection.
Observational Model: Cohort, Time Perspective: Prospective
Correlation of hepatic extraction fraction (HEF) of future remnant liver function (RLF) obtained from Gd-EOB-DTPA enhanced MRI with postoperative ICG R15 clearance test results
Predicted RLF (HEF mL) = the sum of the individual HEF of each voxel in future remnant segment
3 days (upto 5 days) after surgery
Jeong Min Lee, MD, PhD
Seoul National University Hospital
Korea: Institutional Review Board