Pre-treatment estimation of future remnant liver function using gadoxetic acid MRI in patients with HCC

Background & Aims This study aimed to determine whether the predicted remnant liver function on dynamic hepatocyte-specific contrast media-enhanced magnetic resonance (DHCE-MR) imaging correlates with the results of the indocyanin green retention test (ICG R 15 ) after hepatic resection or radiofrequency ablation (RFA). Methods This prospective multicenter study was approved by the Institutional Review Boards of each hospital. Informed consents were obtained from all. DHCE-MRI and ICG R 15 were performed in 57 patients scheduled to undergo hepatectomy or RFA for hepatocellular carcinoma, once before treatment and repeated on post-treatment day 3. In nine donors and three recipients, DHCE-MRI and ICG R 15 were performed only preoperatively. The predicted remnant liver function (HEFml) was estimated using the hepatic extraction fraction (HEF) multiplied by the remnant liver volume, and compared with post-treatment ICG R 15 . Intra-individual heterogeneity of HEF was assessed using pooled coefficients of variation (CV) among hepatic segments. Finally, development of post-treatment hepatic failure was assessed according to the 50–50 criteria on post-treatment day 5. Results Predicted remnant HEFml showed a negative correlation with post-treatment ICG R 15 ( r =−0.45, p =0.001), whereas liver volume did not ( p >0.05). There were significant correlations between pre-treatment HEFml and pre-treatment ICG R 15 ( r =−0.33, p =0.006) and between post-treatment HEFml and post-treatment ICG R 15 ( r =−0.54, p Conclusions DHCE-MRI using Gd-EOB-DTPA was able to provide both global and segmental liver function information, and post-treatment remnant liver function predicted on pre-treatment DHCE-MRI showed a significant negative correlation with post-treatment ICG R 15 . Lay summary Post-treatment liver function could be predicted at pre-treatment DHCE-MRI. Liver function was heterogeneous among the liver segments. Liver anatomy, disease extent, and underlying liver function can be assessed in one DHCE-MRI examination. Clinical trial number ClinicalTrials.gov number, NCT01490203.