Functional Liver Imaging Score (FLIS) as imaging parameter for predicting post-hepatectomy complications in patients with liver cirrhosis

Abstract

Background

Liver dysfunction has been reported as a risk factor for predicting complications after hepatectomy. In patients with liver cirrhosis (LC) who underwent hepatectomy, a Functional Liver Imaging Score (FLIS), derived from gadoxetic acid–enhanced magnetic resonance imaging (MRI), has never been investigated as a predictor of clinically significant post-hepatectomy complications.

Purpose

To evaluate whether FLIS can predict post-hepatectomy complications in patients with LC.

Material and Methods

A retrospective review was conducted of patients with LC who underwent gadoxetic acid–enhanced MRI and hepatectomy. Univariable and multivariable logistic regression was used to identify clinicopathological and radiologic findings associated with the development of major complication (Clavien–Dindo classification [CDC] ≥ III). Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of FLIS for predicting CDC ≥ III.

Results

Of the finally included 106 patients (77 men; mean age = 62.5 ± 8.3 years), 12 patients had a CDC ≥ III. Multivariable analysis showed that only FLIS independently predicted post-hepatectomy complications (odds ratio = 0.02; P = 0.01). ROC analysis suggested the FLIS ≤ 4 was the optimal cutoff for predicting CDC ≥ III (AUC value = 0.94; sensitivity = 91.67%; specificity = 95.74%; positive likelihood ratio = 21.54; and negative likelihood ratio = 0.09).

Conclusion

In patients with LC, FLIS was an independent predictor of post-hepatectomy complications. FLIS showed excellent diagnostic performance in predicting post-hepatectomy complications.