Predicting post-hepatectomy liver failure based on future remnant liver function combined with future remnant liver volume using magnetic resonance imaging

Purpose Significant advances have been made in image-based determinations of future remnant liver function, in attempts to better predict post-hepatectomy liver failure (PHLF). We have reported time-associated liver functional assessments using magnetic resonance imaging with liver-to-spleen signal intensity ratio increasing rate (LSRi) and LSRi of the future remnant liver region (LSRi-rem) to predict PHLF. This study aimed to investigate the predictability of PHLF by a preoperative liver function assessment index that combined LSRi-rem and future remnant liver volume (FRLV). Methods Participants comprised 333 patients who underwent EOB-MRI for the diagnosis of liver tumor before major hepatectomy between 2009 and 2024. LSRi-rem was evaluated by three-dimensional volumetric analysis, and the volume adjusted LSRi-rem (vaLSRi-rem) was calculated using the following formula: LSRi-rem × (FRLV / whole-liver volume). The vaLSRi-rem and clinical variables were then analyzed to assess the risk of PHLF. Results In patients with vaLSRi-rem < 0.147, right hepatectomy, operation time ≥ 400 min, and estimated blood loss ≥ 1495 mL were associated with clinically relevant PHLF ( P  < 0.05 each) in multivariable analysis. Multivariable analysis showed the highest odds ratio (OR) for vaLSRi-rem (OR 9.12; P  < 0.01). Of the 333 patients, 114 (34%) underwent portal vein embolization before major hepatectomy. The OR of vaLSRi-rem from multivariable analysis in this patient cohort was particularly high (OR 21.04; P  < 0.01). Conclusions Strong associations were identified between vaLSRi-rem and clinically relevant PHLF after major hepatectomy, particularly among portal vein embolization patients.