The Clinical Value Of Gd-EOB-DTPA Enhanced MRI For Predicting Post-hepatectomy Liver Failure In Patients With Hepatocellular Carcinoma

Part Ⅰ Correlation between Gd-EOB-DTPA enhanced MRI parameters from hepatobiliary phase and hepatic functional reserve in patients with hepatocellular carcinomaObjective:To investigate the correlation between gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI parameters from hepatobiliary phase and hepatic functional reserve in patients with hepatocellular carcinoma(HCC).Materials and methods:61 patients with HCC who underwent indocyanine green(ICG)clearance test and GdEOB-DTPA enhanced MRI within one week were retrospectively analyzed.Relevant laboratory indicators were collected within 1 week within ICG clearance test.Child-Pugh score,albumin-bilirubin score(ALBI),model for end-stage liver disease(MELD),aspartate transferase to platelet ratio index(APRI)and fibrosis-4 index(FIB-4)were evaluated and calculated.Quantitative parameters from hepatobiliary phase,including signal intensity(SI)margin of liver parenchyma or portal vein,corrected relative liver enhancement(cRLE),liver to portal vein contrast ratio(LPC),were measured and calculated.Functional liver imaging score(FLIS)were evaluated.Spearman method was used for correlation analysis.Results:Prothrombin time(PT),international normalized ratio(INR),platelet(PLT),serum albumin(ALB),total bilirubin(TBIL),aspartate aminotransferase(AST),alkaline phosphatase(ALP),glutamyl transpeptidase(GGT),total bile acid(TBA),serum cholinesterase(CHE),ALBI,MELD,APRI,FIB-4 and ICG retention rate at 15 min(ICG R15)were all correlated,and the absolute value of correlation coefficients ranged from 0.269 to 0.573.It was also correlated with SI of liver,cRLE,LPC and FLIS.The correlation coefficients were-0.281,-0.338,-0.380 and-0.309,respectively(all P<0.05).Conclusion:Gd-EOB-DTPA enhanced MRI parameters from hepatobiliary phase are correlated with hepatic functional reserve in patients with HCC.Part Ⅱ Preoperative prediction of post-hepatectomy liver failure by Gd-EOB-DTPA enhanced MRI parameters from hepatobiliary phase in patients with hepatocellular carcinomaObjective:To investigate the clinical value of preoperative prediction of post-hepatectomy liver failure(PHLF)by Gd-EOB-DTPA enhanced MRI parameters from hepatobiliary phase in patients with HCC,and to compare the discriminatory power of different imaging and clinical biochemical parameters in the prediction of PHLF.Materials and methods:156 patients with HCC who underwent Gd-EOB-DTPA enhanced MRI two weeks before liver resection surgery were retrospectively analyzed.According to the international study group of liver surgery(ISGLS),the patients were divided into 52 patients with PHLF and 104 patients without PHLF.Laboratory indicators,clinical and surgical data of all patients within 1 week MRI examination were consulted and collected.Child-Pugh,ALBI,MELD,APRI and FIB-4 scores were calculated according to the collected clinical and laboratory indicators.cRLE,LPC and FLIS of patients were calculated or evaluated.Independent-samples t test,Mann-Whitney U test,chi-square test or Fisher’s exact were used to compare the differences among groups.P<0.05 was considered statistically significant.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy.Compare the area under the curve(AUC)via Delong test.Results:There were significant differences in age,PLT,GGT,TBA,CHE,operation time,ALBI,FIB-4 score and cRLE,LPC,FLIS between PHLF and non-PHLF patients(P<0.05).The AUCs of clinical indicators ranged from 0.614 to 0.673.The AUCs of ALBI,FIB-4,cRLE,LPC and FLIS were 0.605,0.629,0.659,0.605 and 0.637,respectively.There was no statistical difference among all AUCs(P>0.05).Conclusion:Gd-EOB-DTPA enhanced MRI derived parameters from hepatobiliary phase have certain clinical value for the prediction of PHLF,but there is no significant advantage compared with clinical laboratory examination.Part Ⅲ Prediction of post-hepatectomy liver failure based on radiomics using Gd-EOB-DTPA enhanced MR hepatobiliary phase images in patients with hepatocellular carcinomaObjective:To investigate the clinical value of radiomics using Gd-EOB-DTPA enhanced MR hepatobiliary phase imaging in predicting PHLF in patients with hepatocellular carcinoma,and whether combined with clinical indicators can improve the predictive efficacy.Materials and methods:Hepatobiliary phase images of 156 patients from part Ⅱ were randomly divided 7:3 for training and the test cohorts through the uAI radiomics platform.Pretreatment using the maxmin normalization and dimensionality reduction using least absolute shrinkage and selection operator(LASSO),select the most relevant radiomics characteristics.Obtained radiomics score(Rad-score)via linear calculation.The radiomics model was built.The clinical and imaging measurement/evaluation parameters from part Ⅱ were also modeled by the training group and verified by the test group.The clinical indicators and Rad-score in the training group were analyzed by univariate and multivariate logistic regression,and identify clinical variables associated with PHLF or independent risk factors.The clinical-radiomics combined prediction model was constructed.AUC was used to quantify the predictive effectiveness of all models.Delong test was used to compare the predictive effectiveness of AUC between models or other parameters.The test group was used to verify the model.Results:After pretreatment and dimensionality reduction,12 most relevant features were selected from all 2600 texture features,including 2 first-order features,1 shape feature,4 gray-level cooccurrence matrix(GLCM),2 gray-level dependence matrix(GLDM),1 gray-level run length matrix(GLRLM)and 2 gray-level size zone matrix(GLSZM).The AUC of radiomics model was 0.819 in the training group and 0.784 in the test group according to the above 12 features.INR,operation time and Rad-score were combined to construct the clinical-radiomics combined prediction model.The AUC of the combined model in the training group and the test group were 0.874 and 0.843,respectively,which showed significant differences compared with other clinical indicators and imaging measurement parameters by Delong test(P<0.05).Conclusion:The combined model developed based on Gd-EOB-DTPA enhanced MR hepatobiliary phase images and clinical indicators showed predictive performance in the postoperative PHLF of patients with liver cancer,which can be used for early prediction of PHLF,and the radiomics model can be used for preoperative prediction,thus optimizing the formulation of treatment strategies for patients with liver cancer who are scheduled to undergo hepatectomy.