Liver failure after hepatectomy: A risk assessment using the pre-hepatectomy shear wave elastography technique |
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| Affiliation: | 1. Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China;2. Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China;1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;3. Department of Dermatology, Duke University Medical Center, Durham, North Carolina;4. Department of Sociology, University of Macau, Taipa, Macau, China;6. Department of Clinical Trials Statistics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina;5. Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;1. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2. Department of Ultrasound, Taicang First People''s Hospital, Taicang 215400, China;2. Bristol Centre for Surgical Research, University of Bristol, Bristol, United Kingdom |
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| Abstract: | ObjectiveTo determine the efficacy of liver stiffness (LS) measurements utilizing the Shear Wave Elastography (SWE) technique for predicting post-hepatectomy liver failure (PHLF) among patients with hepatocellular carcinoma (HCC).MethodsData from eighty consecutive patients who were undergoing hepatectomy for HCC were prospectively identified and evaluated with preoperative SWE. The SWE was measured with advanced ultrasound equipment (Philips EPIQ7; Philips Healthcare, Seattle, WA, USA). PHLF classification was defined according to the International Study Group of Liver Surgery Recommendations (ISGLS).ResultsSWE was successfully performed in 77 patients. According to the ISGLS criteria, PHLF occurred in 35.1% of patients (27 patients), including 2/25 patients with Grade A/B, respectively. Elevated SWE values (P = 0.002) and histological cirrhosis (P = 0.003) were independent predictors of PHLF according to the multivariate analysis. Patients with SWE values higher than or equal to 6.9 kPa were identified at higher risk of PHLF (area under the curve: 0.843, sensitivity: 77.8% and specificity: 78.0%). Postoperative dynamic course of the median the Model For End-stage Liver Disease (MELD) score showed irregular changes among patients with an SWE >6.9 kPa. Patients with an SWE <6.9 kPa, postoperative dynamic course of the median MELD score gradually decreased.ConclusionLS measured with SWE is a valid and reliable method for the prediction of PHLF grade A/B among patients with HCC. SWE could become a routine examination for the preoperative evaluation of PHLF. |
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| Keywords: | Liver failure Hepatocellular carcinoma Shear wave elastography |
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