Hepatectomy risk assessment with functional magnetic resonance imaging (HEPARIM)

Mohamed Elsharif, Matthew Roche, Daniel Wilson, Susmita Basak, Ian Rowe, Dhakshina Vijayanand, Richard Feltbower, Darren Treanor, Lee Roberts, Ashley Guthrie, Raj Prasad, Mark S Gilthorpe, Magdy Attia, Steven Sourbron, Mohamed Elsharif, Matthew Roche, Daniel Wilson, Susmita Basak, Ian Rowe, Dhakshina Vijayanand, Richard Feltbower, Darren Treanor, Lee Roberts, Ashley Guthrie, Raj Prasad, Mark S Gilthorpe, Magdy Attia, Steven Sourbron

Abstract

Background: Post hepatectomy liver failure (PHLF) remains a significant risk in patients undergoing curative liver resection for cancer, however currently available PHLF risk prediction investigations are not sufficiently accurate. The Hepatectomy risk assessment with functional magnetic resonance imaging trial (HEPARIM) aims to establish if quantitative MRI biomarkers of liver function & perfusion can be used to more accurately predict PHLF risk and FLR function, measured against indocyanine green (ICG) liver function test.

Methods: HEPARIM is an observational cohort study recruiting patients undergoing liver resection of 2 segments or more, prior to surgery patients will have both Dynamic Gadoxetate-enhanced (DGE) liver MRI and ICG testing. Day one post op ICG testing is repeated and R15 compared to the Gadoxetate Clearance (GC) of the future liver remnant (FLR-GC) as measure by preoperative DGE- MRI which is the primary outcome, and preoperative ICG R15 compared to GC of whole liver (WL-GC) as a secondary outcome. Data will be collected from medical records, biochemistry, pathology and radiology reports and used in a multi-variate analysis to the value of functional MRI and derive multivariant prediction models for future validation.

Discussion: If successful, this test will potentially provide an efficient means to quantitatively assess FLR function and PHLF risk enabling surgeons to push boundaries of liver surgery further while maintaining safe practice and thereby offering chance of cure to patients who would previously been deemed inoperable. MRI has the added benefit of already being part of the routine diagnostic pathway and as such would have limited additional burden on patients time or cost to health care systems. (Hepatectomy Risk Assessment With Functional Magnetic Resonance Imaging - Full Text View - ClinicalTrials.gov , n.d.) TRIAL REGISTRATION: ClinicalTrials.gov, ClinicalTrials.gov NCT04705194 - Registered 12th January 2021 - Retrospectively registered.

Keywords: Functional MRI; Future liver remnant; Gadoxetate; Indocyanine green; Post hepatectomy liver failure; Risk assessment.

Conflict of interest statement

SPS has a research collaboration with Bayer AG in the TRISTAN project (www.imi-tristan.eu) and Bayer AG co-funds a CASE studentship under the supervision of SPS.

AG has attended a conference funded by Bayer and received honoraria from Bayer as a speaker.

The other authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Pathway demonstrating patients route through the trial in both the primary surgical and portal vein embolisation arms. Items in blue are unique to trial patients
Fig. 2
Fig. 2
Predicted ICG-C (top) and error in the predicted ICG-C (bottom) for the lowest precision simulated

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