Regional Liver Function Assessment Using Free-breathing T1 Mapping in Gadoxetic Acid–enhanced MRI for Patients with Bile Duct Cancer: A Prospective Study

Purpose: In this prospective study, we aimed to test the feasibility of dynamic Gd-EOB-DTPA-enhanced MRI with a free-breathing T1 mapping technique in a single scan and examine the influence of functional future liver remnant(FLR) on the incidence of post-hepatectomy liver failure(PHLF) in patients who underwent major liver resection for suspected bile duct cancer(BTC) after bile drainage. Method: Patients were included for suspected biliary tract tumor with a plan for hepatectomy in this prospective study between 2020 and 2022. Patients were excluded if artifacts existed on images or with a history of radiotherapy or chemotherapy before surgery. PHLF was defined and graded according to the International Study Group of Liver Surgery(ISGLS) criterion. All the scans were performed on a 3.0 T MR scanner (Philips Healthcare) and functional liver indexes were calculated accordingly. GOAL-SNAP sequence was optimized for quantifying T1 of the liver including an inversion recovery (IR) preparation pulse followed by a series of 3D golden angle radial acquisition. Results: Total 49 patients met the inclusion criteria and completed preoperative routine MRI sequence, among whom 33 patients completed additional free-breathing T1 mapping sequence. Perihilar cholangiocarcinoma was the main clinical diagnosis on admission in 46 patients. The other diagnoses were carcinoma of common bile duct and gallbladder carcinoma(n=3). △T1, △T1%, HEF(n=33) and UR(n=32) of the whole liver have statistical significance correlations with preoperative liver biochemical indexes and ICG test(Fig. 1). In this study, 39 patients finally underwent major liver resection and thus were included for PHLF analysis. According to ISGLS criterion, 16 patients happened PHLF which 10 patients were diagnosed in grade B and C.There were no difference between PHLF and NO PHLF groups in surgical characteristics. Univariable and multivariable analysises for PHLF were shown in Table 1(Results with P<0.05). Conclusion: In this prospective study, the correlation results have demonstrated MRI parameters' clinical feasibility for liver function estimation in patients with BTC. The proposed functional liver volume rate (45%) could be considered as an important factor influencing PHLF in BTC patients, and therefore it provides functional reference for selection of patients underwent hepatectomy instead of using CT-based volumetric calculation when MRI is available.Tabled 1Table 1VariablesUnivariable analysisMultivariable analysisOR (95% CI)pOR (95% CI)pPT, sec2.52(1.29-4.93)0.0072.57(1.21-5.42)0.01APTT, sec1.51(1.12-2.03)0.0071.72(1.16-2.53)0.007sFLRRE10, %0.01(0.00-0.68)0.030.004(0.00-0.47)0.02sFLRRE15, %0.003(0.00-0.37)0.020.002(0.00-0.43)0.02sFLRRE15<45%6.12(1.42-26.36)0.026.50(1.17-36.05)0.03sFLRRE20, %0.003(0.00-0.31)0.020.001(0.00-0.37)0.02sFLRRE20<45%5.67(1.37-23.46)0.026.11(1.13-33.09)0.03FLRHEF, ml0.99(0.97-0.99)0.030.98(0.97-0.99)0.04 Open table in a new tab