Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure

Wolf C Bartholomä; Stefan Gilg; Peter Lundberg; Peter N Larsen; Ville Sallinen; Malin Sternby Eilard; Jozef Urdzik; Gert Lindell; Torkel B Brismar; Eva Fallentin; Ali Ovissi; Andreas Socratous; Tomas Bjerner; Sophie Kollbeck; Jens Tellman; Fredrik Holmquist; Nils Dahlström; Mischa Woisetschläger; Bergthor Björnsson; Ernesto Sparrelid; Per Sandström

doi:10.1093/bjs/znaf103

Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure

Wolf C Bartholomä^*, Stefan Gilg, Peter Lundberg, Peter N Larsen, Ville Sallinen, Malin Sternby Eilard, Jozef Urdzik, Gert Lindell, Torkel B Brismar, Eva Fallentin, Ali Ovissi, Andreas Socratous, Tomas Bjerner, Sophie Kollbeck, Jens Tellman, Fredrik Holmquist, Nils Dahlström, Mischa Woisetschläger, Bergthor Björnsson, Ernesto SparrelidPer Sandström

^*Corresponding author for this work

4 Citations (Scopus)

Abstract

BACKGROUND: Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF.

METHODS: This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C).

RESULTS: Among the 292 patients, 25 (8.6%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P < 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803).

CONCLUSION: The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.

Original language	English
Article number	znaf103
Journal	The British journal of surgery
Volume	112
Issue number	5
ISSN	0007-1323
DOIs	https://doi.org/10.1093/bjs/znaf103
Publication status	Published - 30 Apr 2025

Keywords

Humans
Hepatectomy/adverse effects
Male
Female
Liver Failure/etiology
Magnetic Resonance Imaging/methods
Retrospective Studies
Middle Aged
Aged
Postoperative Complications/etiology
Gadolinium DTPA
Risk Assessment/methods
Liver/diagnostic imaging
Contrast Media
Adult

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Bartholomä, W. C., Gilg, S., Lundberg, P., Larsen, P. N., Sallinen, V., Sternby Eilard, M., Urdzik, J., Lindell, G., Brismar, T. B., Fallentin, E., Ovissi, A., Socratous, A., Bjerner, T., Kollbeck, S., Tellman, J., Holmquist, F., Dahlström, N., Woisetschläger, M., Björnsson, B., ... Sandström, P. (2025). Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure. The British journal of surgery, 112(5), Article znaf103. https://doi.org/10.1093/bjs/znaf103

Bartholomä, WC, Gilg, S, Lundberg, P, Larsen, PN, Sallinen, V, Sternby Eilard, M, Urdzik, J, Lindell, G, Brismar, TB, Fallentin, E, Ovissi, A, Socratous, A, Bjerner, T, Kollbeck, S, Tellman, J, Holmquist, F, Dahlström, N, Woisetschläger, M, Björnsson, B, Sparrelid, E & Sandström, P 2025, 'Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure', The British journal of surgery, vol. 112, no. 5, znaf103. https://doi.org/10.1093/bjs/znaf103

@article{44d9df7a007c463a90ffd7cf58c0ba34,

title = "Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure",

abstract = "BACKGROUND: Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF.METHODS: This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C).RESULTS: Among the 292 patients, 25 (8.6\%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P < 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803).CONCLUSION: The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.",

keywords = "Humans, Hepatectomy/adverse effects, Male, Female, Liver Failure/etiology, Magnetic Resonance Imaging/methods, Retrospective Studies, Middle Aged, Aged, Postoperative Complications/etiology, Gadolinium DTPA, Risk Assessment/methods, Liver/diagnostic imaging, Contrast Media, Adult",

author = "Bartholom{\"a}, \{Wolf C\} and Stefan Gilg and Peter Lundberg and Larsen, \{Peter N\} and Ville Sallinen and \{Sternby Eilard\}, Malin and Jozef Urdzik and Gert Lindell and Brismar, \{Torkel B\} and Eva Fallentin and Ali Ovissi and Andreas Socratous and Tomas Bjerner and Sophie Kollbeck and Jens Tellman and Fredrik Holmquist and Nils Dahlstr{\"o}m and Mischa Woisetschl{\"a}ger and Bergthor Bj{\"o}rnsson and Ernesto Sparrelid and Per Sandstr{\"o}m",

note = "{\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.",

year = "2025",

month = apr,

day = "30",

doi = "10.1093/bjs/znaf103",

language = "English",

volume = "112",

journal = "The British journal of surgery",

issn = "0007-1323",

publisher = "Oxford University Press",

number = "5",

}

TY - JOUR

T1 - Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure

AU - Bartholomä, Wolf C

AU - Gilg, Stefan

AU - Lundberg, Peter

AU - Larsen, Peter N

AU - Sallinen, Ville

AU - Sternby Eilard, Malin

AU - Urdzik, Jozef

AU - Lindell, Gert

AU - Brismar, Torkel B

AU - Fallentin, Eva

AU - Ovissi, Ali

AU - Socratous, Andreas

AU - Bjerner, Tomas

AU - Kollbeck, Sophie

AU - Tellman, Jens

AU - Holmquist, Fredrik

AU - Dahlström, Nils

AU - Woisetschläger, Mischa

AU - Björnsson, Bergthor

AU - Sparrelid, Ernesto

AU - Sandström, Per

N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.

PY - 2025/4/30

Y1 - 2025/4/30

N2 - BACKGROUND: Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF.METHODS: This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C).RESULTS: Among the 292 patients, 25 (8.6%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P < 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803).CONCLUSION: The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.

AB - BACKGROUND: Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF.METHODS: This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C).RESULTS: Among the 292 patients, 25 (8.6%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P < 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803).CONCLUSION: The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.

KW - Humans

KW - Hepatectomy/adverse effects

KW - Male

KW - Female

KW - Liver Failure/etiology

KW - Magnetic Resonance Imaging/methods

KW - Retrospective Studies

KW - Middle Aged

KW - Aged

KW - Postoperative Complications/etiology

KW - Gadolinium DTPA

KW - Risk Assessment/methods

KW - Liver/diagnostic imaging

KW - Contrast Media

KW - Adult

UR - https://www.scopus.com/pages/publications/105007130160

U2 - 10.1093/bjs/znaf103

DO - 10.1093/bjs/znaf103

M3 - Journal article

C2 - 40439010

SN - 0007-1323

VL - 112

JO - The British journal of surgery

JF - The British journal of surgery

IS - 5

M1 - znaf103

ER -

Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure

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