Acoustic radiation force impulse imaging predicts postoperative ascites resulting from curative hepatic resection for hepatocellular carcinoma

doi:10.1016/j.surg.2011.12.035

Surgery

Volume 151, Issue 6, June 2012, Pages 837-843

https://doi.org/10.1016/j.surg.2011.12.035 Get rights and content

Background

Measurement of liver stiffness using Virtual Touch Tissue Quantification (VTTQ) based on acoustic radiation force impulse imaging reflects the degree of hepatic fibrosis and reserve. This prospective study investigated how well the VTTQ value predicts the development of postoperative complications before curative hepatic resection for hepatocellular carcinoma (HCC).

Methods

The study enrolled 50 consecutive patients between February 2009 and October 2010 whose preoperative VTTQ values were determined before they underwent curative hepatic resection for HCC. We assessed the relationship between postoperative complications and VTTQ values.

Results

The study included 41 (82%) patients with chronic hepatitis and 9 (18%) with nonviral cirrhosis. The mean VTTQ value was 1.60 (m/sec), which correlated with the fibrosis stage (P = .0058). The VTTQ value was the only variable correlated with postoperative ascites that did not respond to pharmacologic treatment and required invasive management. Univariate and subsequent multivariate analyses revealed that the preoperative VTTQ value was the only independent risk factor for predicting the development of postoperative ascites (cutoff, 1.68 cm/sec; P = .007; odds ratio, 76.481). The area under the receiver operating characteristic curve for the diagnosis of postoperative ascites using VTTQ values was 0.90, whereas those using the aspartate transaminase-to-platelet ratio index and indocyanine green retention rate at 15 minutes values were 0.68 and 0.55, respectively.

Conclusion

These data suggest that the VTTQ value is a reliable surrogate marker for predicting postoperative ascites before curative hepatic resection for HCC.

Section snippets

Patients

In this pilot study, 50 consecutive patients who were eligible for curative hepatic resection for hepatocellular carcinoma (HCC) were enrolled prospectively between February 2009 and October 2010 at Kyushu University Hospital, Japan. We excluded patients who underwent operation because of other conditions or were scored as Child-Pugh class C. Thirty-four patients expressed the hepatitis C virus antibody (HCVAb), 5 were positive for hepatitis B virus surface antigen (HBsAg), 2 were positive for

Patients characteristics, operations, and tumor staging

Patient characteristics are summarized in Table I. The mean age of the patients (36 men and 14 women) was 68 ± 10 years. The surgical specimens of 50 HCCs revealed a background of chronic hepatitis in 41 cases (82%) and cirrhosis (F4) in 11 cases (22%). The preoperative serum creatinine level was 1.1 ± 0.2 mg/dL, the MELD score was 8.3 ± 0.4, and the VTTQ value was 1.6 ± 0.4 cm/sec. The tumor sites were right lobe (n = 27), left lobe (n = 15), and both (n = 8). The median amount of operative

Discussion

In clinical situations, we preoperatively evaluate parameters of liver function always such as the conventional Child-Pugh grade and ICG R15 in patients with potentially curative HCC. Moreover, we assess liver stiffness by APRI and computed tomography to avoid postoperative complications. Regardless of the conventional preoperative assessment of liver function and stiffness, however, we still encounter patients who develop postoperative ascites, do not respond to drug therapy and require

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Posthepatectomy liver failure (PHLF) is a potentially fatal complication, and the accurate prediction of PHLF is essential. Liver stiffness measurement (LSM) has been accepted widely as a noninvasive assessment for liver fibrosis. We aimed to evaluate the usefulness of LSM in predicting PHLF.
One hundred seventy-seven patients with hepatocellular carcinoma who underwent liver resection between August 2011 and October 2014 were analyzed prospectively. LSM was performed by Virtual Touch Tissue Quantification based on acoustic radiation force impulse imaging, and its value was expressed as the shear wave velocity (Vs) [m/s]. The remnant liver volume rate (Rem) was calculated by computed tomography volumetry. PHLF was diagnosed on the basis of the definition from the International Study Group of Liver Surgery.
PHLF occurred in 38 patients (21.5%): grade A, 17 patients (9.6%); grade B, 15 patients (8.5%); and grade C, 6 patients (3.4%). The area under the receiver operating characteristic curve of the Vs for predicting PHLF was 0.67 for grade ≥A, 0.78 for grade ≥B, and 0.74 for grade C, which was greater than any other preoperative factor for each grade. Multivariate stepwise selection identified 2 significant factors associated with PHLF grade ≥B: Vs (odds ratio, 2.66; 95% confidence interval, 1.69–4.41, P < .01) and Rem (odds ratio, 0.47; 95% confidence interval, 0.27–0.79, P < .01). The logistic model that included the Vs and Rem resulted in an area under the receiver operating characteristic curve of 0.80 for predicting PHLF grade ≥B.
LSM was useful for the prediction of PHLF and the estimation of the safe Rem range.
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Liver fibrosis is the final common pathway for almost all causes of chronic liver injury. Liver fibrosis is now known to be a dynamic process having significant potential for resolution. Therefore, fibrosis prediction is an essential part of the assessment and management of patients with chronic liver disease. As such, there is strong demand for reliable liver biomarkers that provide insight into disease etiology, diagnosis, therapy, and prognosis in lieu of more invasive approaches such as liver biopsy. Current diagnostic strategies range from use of serum biomarkers to more advanced imaging techniques including transient elastography and magnetic resonance imaging. In addition to these modalities, there are other approaches including the use of novel, but yet to be validated, biomarkers. In this chapter, we discuss the biomarkers of liver fibrosis including the use of invasive and noninvasive biomarkers and disease-specific biomarkers in various chronic liver diseases.
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Original CommunicationAcoustic radiation force impulse imaging predicts postoperative ascites resulting from curative hepatic resection for hepatocellular carcinoma

Background

Methods

Results

Conclusion

Section snippets

Patients

Patients characteristics, operations, and tumor staging

Discussion

J Am Coll Surg

Gastroenterology

Hepatology

Surgery

Gastroenterology

J Hepatol

Hepatology

J Am Coll Surg

Hepatic resection for hepatocellular carcinoma, An audit of 343 patients

Ann Surg

No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? a prospective analysis of our approach

Arch Surg