Liver Intrinsic Function Evaluation (LIFE): Multi-parametric Liver Function Profiles of Patients Undergoing Hepatectomy

Background & Aims For a range of liver malignancies, the only curative treatment option may be hepatectomy, which may have fatal complications. Therefore, an unbiased pre-operative risk assessment is vital, however, at present the assessment is typically based on global liver function only. Magnetic resonance imaging (MRI) modalities have the possibility to aid this assessment, by introducing additional characterization of liver parenchymal, such as non-invasive quantification of steatosis, fibrosis, and uptake function, both for global and regional assessment. To this cause, we here present a prospective observation study (LIFE), in which patients underwent extensive MR-examinations both before and after resective-surgery. Approach and Results A total of 13 patients undergoing hepatectomy underwent a pre- (n=13) and post (m=5) multimodal MRI examination (within 3-5 days of the surgery) ([Fig. 1B][1]). The multimodal MR-examination included DCE, 3D-MRE, fat fraction measurements (PDFF by MRS, 6PD). Using these measurements, we also construct individual patient profiles by including conventional functional, and volumetric measurements, into a multi-parametric space. As a proof of concept, the areas of each profile, denoted ‘multiparametric profile area’ (MPA, and aMPA) were calculated, to create a measurement comprising information from all modalities. At a group-level, no clear pattern emerged of MPA or aMPA between groups with different extent of resection. In contrast, on a case-by-case basis, several parameters contributed to high individual MPA or aMPA-values, suggesting tissue abnormalities. With respect to regional DCE measurements, i.e ., relative enhancement at 20 minutes, a clear variation between function in segments, within and between the individuals, was observed. Conclusions In this combined pre- and post-observational case-based study ranging from very extensive (i) liver surgery to minor (ii), or none (iii), we aimed to describe how a multi-modal MRI examination before hepatectomy could yield valuable information for the pre-operative assessment, with a particular focus on a Couinaud-segmental level. The use of a multi-modal approach allows for a broad spectral characterization of several aspects of the remnant tissue. However, the effectiveness and clinical benefit of each parameter, and how to further optimize an abbreviated clinical MR-protocol needs to be confirmed. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was gratefully supported by funding from the Swedish National Research Council (PL), and the County Council of Ostergotland, Sweden. ### 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: The Linkoping University Hospital ethics committee approved this study, and written informed consent was obtained from all patients (Dnr. M160-09 and rev100615). 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 * BCP : Body Composition Profile HUI : Hepatocellular Uptake Index MOF : Multiple Organ Failure MRCP : Magnetic Resonance Cholangiopancreatography MRE : Magnetic Resonance Elastography MRS : Magnetic Resonance Spectroscopy PC : Peritoneal Carcinoma PD : Point Dixon PDFF : Proton Density Fat Fraction PRESS : Point-RESolved Spectroscopy qMRI : Quantitative MRI SI : Signal Intensity [1]: #F1