Purpose: To evaluate posthepatectomy liver failure (PHLF) using gadoxetic acid-enhanced magnetic\nresonance imaging (MRI) with a measure of relative liver enhancement (RLE) on hepatobiliary\nphase images, thereby facilitating safe liver resection. Methods: Twenty patients in Child-\nPugh class A underwent tumor excision surgery and indocyanine green (ICG) clearance of future\nremnant liver (FRL) (ICG-Krem) values were >0.05. PHLF was evaluated using the grading system\nof the International Study Group of Liver Surgery (ISGLS). The RLE value was defined as the signal\ngain percentage between the precontrast and hepatocellular images. In the whole liver and FRL,\ntheRLE value measured the tumor-free liver parenchyma in RLE images. We examined the correlation\nbetween indocyanine green clearance (ICG-K) and MRI-based liver function in the whole\nliver. Preoperative PHLF evaluation was predicted using remnant hepatocellular uptake index\n(rHUI), remnant RLE (rRLE), coefficient variation of Rrle [Cv(rRLE)], and ICG-Krem corrected by\nheterogeneous liver function(HLF-ICG-Krem). Results: HLF-ICG-Krem and rRLE values correlated\nwith INRs after postoperative day five (r = âË?â??0.55 and 0.46, p = 0.01 and 0.04, respectively). Furthermore,\nHLF-ICG-Krem values ââ?°Â¤0.05 detected two patients with higher INRs after postoperative\nday five. On the other hand, neither rHUI nor Cv(rRLE) was correlated with INRs after postoperative day five (r = 0.28, and âË?â??0.03, respectively; p > 0.05 for both). HLF-ICG-Krem was significantly lower\nwith PHLF than without PHLF (p = 0.005). Conclusion: HLF-ICG-Krem is useful for evaluating PHLF\nmore correctly.
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