Quantitative liver health imaging improves clinical outcomes in colorectal liver metastasis surgery.

Introduction Post-hepatectomy liver failure (PHLF), driven by insufficient volume and quality of the remnant liver following an operation, is a significant clinical problem that is currently underserved by pre-operative assessment methods. Clinical management and a patient's recovery from post-operative liver related complications results in a protracted stay in hospital. Methods 91 patients with colorectal liver metastasis being considered for liver resection were recruited onto the Precision1 trial. The imaging report from an additional non-quantitative multiparametric MRI (mpMRI) scan was examined and used to alter surgical decision making. Patient outcomes were monitored and evaluated against a standard of care comparator dataset blinded to mpMRI scan results. Results Previously undiagnosed liver disease activity or elevated liver fat was detected using mpMRI in 23% of patients, whereas the liver health was unexpectedly good in 7% of patients; this resulted in a change to surgical plan in 29% of cases. The incidence of protracted (over 14 days) length of stay was reduced from 5% to 1% following the introduction of mpMRI reports into surgical decision-making process. Conclusion mpMRI is a safe method to evaluate liver health in patients being considered for liver resection. Surgical decision making can be altered to achieve a safer treatment strategy resulting in shorter hospital stays for patients. ### Competing Interest Statement JC, SK, JMB, RB are employees and shareholders at Perspectum Ltd. ### Clinical Trial NCT04597710 ### Clinical Protocols ### Funding Statement This study was funded by InnovateUK. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Brighton and Sussex Research Ethics Committee (REC Reference 20/PR/0222). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors