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The value of IVIM for preoperative evaluation of liver regeneration after hepatectomy in hepatocellular carcinoma
Qian Li1, Tong Zhang1, Lisha Nie2, Xiaocheng Wei2, Yi Wei1, and Bin Song1,3
1Department of radiology, West China hospital, Sichuan Univeristy, Chengdu, China, 2MR Research China, GE Healthcare, Beijing,China, Beijing, China, 3Department of radiology, Sanya People’s Hospital, Sanya, China

Synopsis

Keywords: Liver, Diffusion/other diffusion imaging techniques, Liver regeneration; Intravoxel incoherent motion; Carcinoma, Hepatocellular; Hepatectomy

The D value derived from IVIM diffusion-weighted imaging may be a useful marker for the preoperative prediction of liver regeneration in patients with HCC. and the D value derived from IVIM diffusion-weighted imaging shows a significant negative correlation with fibrosis, an important predictor of liver regeneration. No IVIM parameters were associated with liver regeneration in patients who underwent major hepatectomy, but the D value was a significant predictor of liver regeneration in patients who underwent minor hepatectomy.

Purpose

To evaluate the role of intravoxel incoherent motion (IVIM) parameters in the preoperative assessment of liver regeneration.

Material and Methods

Fifty-four HCC patients (45 men and 9 women, mean age 51.26±10.41 years) were retrospectively analysed. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), pseudodiffusion component fraction (f), diffusion distribution coefficient (DDC) and diffusion heterogeneity index (Alpha) were obtained by two independent radiologists. Spearman’s correlation test was used to assess correlations between IVIM parameters and the regeneration index (RI), calculated as 100% × (the volume of the postoperative remnant liver - the volume of the preoperative remnant liver) / the volume of the preoperative remnant liver. Multivariate linear regression analyses were used to identify the factors related to RI.

Results

The intraclass correlation coefficient (ICC) ranged from 0.842-0.918. In all patients, the D value was a significant predictor (P<0.05) of RI in Spearman’s correlation test and multivariate analysis. The fibrosis stage was reclassified as F0–1 (n = 10), F2–3 (n = 26), and F4 (n = 18) using the METAVIR system. The D value showed a moderate correlation with fibrosis stage (r = -0.361, P=0.007). Furthermore, fibrosis stage showed a negative correlation with RI (r = -0.263, P=0.015). In the 29 patients who underwent minor hepatectomy, the D value showed a positive association (P<0.05) with RI in multivariate analysis and a negative correlation with fibrosis stage (r =-0.360, P=0.018). However, in the 25 patients who underwent major hepatectomy, no IVIM parameters were associated with RI (P>0.05).

Conclusion

The D value may be a reliable preoperative predictor of liver regeneration.

Acknowledgements

This work was supported by Science and Technology Support Program of Sichuan Province (Grant number 2021YFS0021、2021YFS0144), Post-Doctor Research Project, West China Hospital, Sichuan University (Grant number 2020HXBH130),

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Figures

A male had a high regeneration index (65.02%) (A) ADC map: the ADC value was 1.07 × 10−3 mm2/s. (B) D map: the D value was 6.70× 10−4 mm2/s. (C) The axial cross-section image of the preoperative simulated surgical tangent. (D) 3D image of the preoperative simulated surgical tangent with a PHRR of 46.93%. (E) D* map: the D* value was 26.00× 10−3 mm2/s. (F) f map: the f value was 0.372×100%. (G) The axial image of the actual remnant liver in the fifth month after surgery. (H) 3D images of actual remnant liver in the fifth month after surgery. (I) The fibrosis stage was F1 (original magnification, ×10).

A male had a low regeneration index (37.45%). (A) ADC map: the ADC value was 1.22 × 10−3 mm2/s. (B) D map: the D value was 4.20× 10−4 mm2/s. (C) The axial cross-section image of the preoperative simulated surgical tangent. (D) 3D image of the preoperative simulated surgical tangent with a PHRR of 41.32%. (E) D* map: the D* value was 17.90× 10−3 mm2/s. (F) f map: the f value was 0.649×100%. (G) The axial image of the remnant liver in the fourth month after surgery. (H) 3D images of remnant liver in the fourth month after surgery. (I) The fibrosis stage was F4 (original magnification, ×10).

Proc. Intl. Soc. Mag. Reson. Med. 31 (2023)
2246
DOI: https://doi.org/10.58530/2023/2246