Preoperative evaluation of post-hepatectomy liver failure in hepatocellular carcinoma based on gadoxetic acid-enhanced MRI.

Purpose: Post-hepatectomy liver failure (PHLF) is a severe complication after hepatic resection. This explored the value of gadoxetic acid-enhanced MRI quantitative imaging biomarkers of liver function for the preoperative prediction of PHLF in HCC patients. Methods and Materials: This retrospective study included 107 patients undergoing hepatectomy for HCC. All had gadoxetic acid-enhanced MRI preoperatively. Quantitative imaging biomarkers of liver function, including relative liver enhancement (RLE), hepatic uptake index (HUI), contrast uptake index (CUI) and liver-to-spleen index (LSI) were calculated. Intraclass correlation coefficient (ICC) was applied to verify the reproducibility of ROI delineation. Principal Component Analysis (PCA) was used to handle multicollinearity among imaging biomarkers. Multivariate binary logistic regression was used to identify independent risk factors for PHLF and establish preoperative prediction models. Receiver operating characteristic (ROC) curve analysis with DeLong test was performed to compare the predictive efficacy of different models, and decision curve analysis (DCA) was adopted to evaluate the clinical net benefit of the prediction models. Results: Among the 107 patients (95 males, 12 females; mean age 56.2 ± 12.4 years), 29 were PHLF positive, and 78 were negative. Stratified multivariate binary logistic regression analysis revealed that RLE, CUI, HUI and LSI were all independent predictors of PHLF when respectively incorporated into independent models. (RLE OR< 0.001, 95% CI< 0.001-0.368, Conclusion: Quantitative imaging biomarkers of liver function based on gadoxetic acid-enhanced MRI represents a vital preoperative evaluation method.