gms | German Medical Science

Background: Major liver resection is still associated with a significant risk of posthepatectomy liver failure (PHLF) and death. We sought to determine whether preoperative magnetic resonance imaging (MRI) with liver specific contrast agent might help to identify patients endangered for PHLF or even death after resection.

Materials and methods: Between 2013 and 2015, we retrospectively assessed patients that received MRI with liver specific contrast agent (Gd-EOB-DTPA) prior to extended liver resection (≥3 liver segments) at University Hospital Regensburg. Signal intensity was determined before (native) and after (late phase) Gd-EOB-DTPA. The postoperative course was analysed regarding PHLF (“50-50 criteria”, “peak-bili 7”, “ISGLS”) and complications (Dindo-Clavien). Associations between signal intensity and postoperative course were analysed using simple logistic regression models.

Results: 67 patients underwent major liver resection after preoperative MRI due to colorectal liver metastases (n=33), cholangiocarcinoma (n=12), hepatocellular carcinoma (n=12), gallbladder cancer (n=2) and other hepatic processes (n=8). Procedures included right hepatectomy (RH, n=12), left hepatectomy (LH, n=9), extended RH (n=18), extended LH (n=4), RH with atypical resection/ablation on the left side (n=20), LH and atypical resection/ablation on the right side (n=2) and central resection (CR, n=2). PHLF according to “50-50 criteria” occurred in 4 patients (6%), “peak-bili 7” in 9 patients (13.4%) and ISGLS in 19 patients (28.4%). Complications according to Dindo-Clavien ≥°IIIb were observed in 16 patients (23.9%), including 5 postoperative deaths (7.5%). No association was observed between MRI and PHLF according to ISGLS or complications (Dindo-Clavien, except °V). However, patients with PHLF according to “50-50 criteria” and “peak-bili 7” had significantly lower enhancement in the late phase of preoperative MRI scan (“50-50”: 277 (SD 36) vs. 366 (SD 82), odds ratio(OR)=0.98, p=0.033; “peak-bili 7”: 309 (SD 48) vs. 368 (SD 84); OR=0.99, p=0.046). Similar, enhancement in the late phase was significantly lower in patients that died during the hospital stay (291 (SD 54) vs. 366 (SD 82), OR=0.98, p=0.046).

Conclusion: Preoperative MRI with liver specific contrast agent might help to identify patients endangered for PHLF or even death after major liver resection.