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Qiu C, Xie S, Sun Y, Yu Y, Zhang K, Wang X, Zhu J, Grimm R, Shen W. Multi-parametric magnetic resonance imaging of liver regeneration in a standardized partial hepatectomy rat model. BMC Gastroenterol 2022; 22:430. [PMID: 36210451 PMCID: PMC9549623 DOI: 10.1186/s12876-022-02517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to evaluate the correlation between the pathological changes and multi-parameter MRI characteristics of liver regeneration (LR) in a standard partial hepatectomy (PH) rat model.
Methods
Seventy Sprague–Dawley rats were randomly divided into two groups: MR scan group (n = 14) and pathologic analysis (PA) group (n = 56). All 14 rats in the MR group underwent liver T1 mapping, T2 mapping, and diffusion kurtosis imaging before and the 1st, 2nd, 3rd, 5th, 7th, 14th, and 21st day after 70% hepatectomy. Seven rats in the PA group were euthanized at each time point to determine Ki-67 indices, hepatocyte size (HTS), steatosis grade, and inflammation score.
Results
Liver T1 and T2 values increased to maximum on day 2 (P < 0.001 vs. baseline), D and K values decreased to minimum on day 3 and 2, respectively (P < 0.001 vs. baseline), then all parameters returned to baseline gradually. Hepatocyte Ki-67, hepatocyte size, steatosis grade, and inflammation score initially increased after surgery (P < 0.05 vs. baseline), followed by a gradual decline over time. Both T2 and K values correlated well with Ki-67 indices (r = 0.765 and − 0.807, respectively; both P < 0.001), inflammation (r = 0.809 and − 0.724, respectively; both P < 0.001), steatosis grade (r = 0.814 and − 0.725, respectively; both P < 0.001), and HTS (r = 0.830 and − 0.615, respectively; both P < 0.001).
Conclusions
PH induced liver changes that can be observed on MRI. The MRI parameters correlate with the LR activity and allow monitoring of LR process.
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Xie S, Qiu C, Sun Y, Yu Y, Hu Z, Zhang K, Chen L, Cheng Y, Bao M, Zhang Q, Zhu J, Grimm R, Shen W. Assessment of Fibrotic Liver Regeneration After Partial Hepatectomy With Intravoxel Incoherent Motion Diffusion-Weighted Imaging: An Experimental Study in a Rat Model With Carbon Tetrachloride Induced Liver Injury. Front Physiol 2022; 13:822763. [PMID: 35250624 PMCID: PMC8894856 DOI: 10.3389/fphys.2022.822763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To determine whether intravoxel incoherent motion (IVIM) parameters correlate with liver regeneration and function recovery after partial hepatectomy (PH) in rats with carbon tetrachloride (CCl4)-induced liver fibrosis. Methods Sixty-two adult Sprague-Dawley rats were divided into the control group and the fibrosis group with CCl4 injection for 8 weeks. At the end of the 8th week, all rats received left lateral lobe liver resection. Within each group, IVIM imaging (n = 10/group) and histologic and biochemical analyses (n = 3/group/time point) were performed pre- and post-PH (on days 1, 2, 3, 5, 7, 14, and 21). Differences in liver IVIM parameters and correlation between IVIM parameters and Ki-67 indices, hepatocyte diameter, alanine transaminase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) values were analyzed. Results Post-PH, liver true diffusion coefficient (D) values decreased and pseudodiffusion coefficient (D*) and perfusion fraction (PF) values increased, then recovered to pre-PH levels gradually in both fibrosis and control rats. PF in fibrosis group were significantly higher than in controls from 3 to 21 days (P < 0.05). In fibrosis rats, both Ki-67 indices and hepatocyte diameters increased, and a strong correlation was found between PF and Ki-67 indices (r = −0.756; P = 0.03), D* and PF values and ALT, AST, and TBil values (r = −0.762 to −0.905; P < 0.05). In control rats, only hepatocyte diameters increased, and all IVIM parameters correlated well with hepatocyte diameters, ALT, AST and TBil values (r = 0.810 to −1.000; P < 0.05). Conclusion The regeneration pattern in fibrotic liver tissue was different compared with control livers. IVIM parameters can monitor liver regeneration and functional recovery non-invasively after PH.
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Affiliation(s)
- Shuangshuang Xie
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Caixin Qiu
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Yajie Sun
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Yongquan Yu
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Zhandong Hu
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Kun Zhang
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Lihua Chen
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Yue Cheng
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Mingzhu Bao
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Quansheng Zhang
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Jinxia Zhu
- Siemens Healthcare (China), Beijing, China
| | | | - Wen Shen
- Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
- *Correspondence: Wen Shen,
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Zhao J, Gao S, Sun W, Grimm R, Fu C, Han J, Sheng R, Zeng M. Magnetic resonance imaging and diffusion-weighted imaging-based histogram analyses in predicting glypican 3-positive hepatocellular carcinoma. Eur J Radiol 2021; 139:109732. [PMID: 33905978 DOI: 10.1016/j.ejrad.2021.109732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to investigate the potential MR imaging findings in predicting glypican-3 (GPC3)-positive hepatocellular carcinomas (HCCs), with special emphasis on diffusion-weighted imaging (DWI)-based histogram analyses. METHODS Forty-three patients with pathologically-confirmed GPC3-negative HCCs and 100 patients with GPC3-positive HCCs were retrospectively evaluated using contrast-enhanced MRI and DWI. Clinical characteristics and MRI features including DWI-based histogram features were assessed and compared between the two groups. Univariate and multivariate analyses were used to identify the significant clinico-radiologic variables associated with GPC3 expressions that were then incorporated into a predictive nomogram. Nomogram performance was evaluated based on calibration, discrimination, and decision curve analyses. RESULTS Features significantly related to GPC3-positive HCCs at univariate analyses were serum alpha-fetoprotein (AFP) levels >20 ng/mL (P < 0.0001), absence of enhancing capsule (P = 0.040), peritumoral enhancement appearance on the arterial phase (P = 0.049), as well as lower mean (P = 0.0278), median (P = 0.0372) and 75th percentile (P = 0.0085) apparent diffusion coefficient (ADC) values. At multivariate analysis, the AFP levels (odds ratio, 11.236; P < 0.0001) and 75th percentile ADC values (odds ratio, 1.009; P = 0.033) were independent risk factors associated with GPC3-positive HCCs. When both criteria were combined, both sensitivity (79.0 %) and specificity (79.1 %) greater than 75 % were achieved, and satisfactory predictive nomogram performance was obtained with a C-index of 0.804 (95 % confidence interval, 0.729-0.866). Decision curve analysis further confirmed the clinical usefulness of the nomogram. CONCLUSIONS Elevated serum AFP levels and lower 75th percentile ADC values were helpful in differentiating GPC3-positive and GPC3-negative HCCs. The combined nomogram achieved satisfactory preoperative risk prediction of GPC3 expression in HCC patients.
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Affiliation(s)
- Jiangtao Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
| | - Shanshan Gao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, 91052, Erlangen, Germany.
| | - Caixia Fu
- MR Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, 518057, China.
| | - Jing Han
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 20032, China.
| | - Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
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Wu G, Liu X, Xiong Y, Ran J, Li X. Intravoxel incoherent motion and diffusion kurtosis imaging for discriminating soft tissue sarcoma from vascular anomalies. Medicine (Baltimore) 2018; 97:e13641. [PMID: 30558056 PMCID: PMC6320121 DOI: 10.1097/md.0000000000013641] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To investigate the feasibility of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in discriminating soft tissue sarcoma from vascular anomalies.Twenty-two patients with lower extremity soft tissue sarcoma and 15 patients with lower extremity vascular anomalies underwent IVIM-DWI and DKI. IVIM model generated true diffusion (D), perfusion fraction (f), and pseudo-diffusion coefficient (D). DKI model generated mean kurtosis (MK) and mean diffusion (MD). These parameters were measured by 2 radiologists separately through drawing region of interest. Intraclass correlation coefficient (ICC) was calculated to evaluate the inter-reader viability in measurement. The Mann-Whitney test was used to compare the parameters between vascular anomalies and soft tissue sarcoma. Receiver operating characteristic curves were constructed for assessing diagnostic accuracies.ICC was more than 0.8 for apparent diffusion coefficient (ADC), D, D, f, MK, and MD. Mean ADC, D, and MD were significantly lower in soft tissue sarcoma versus vascular anomalies (P < .05). Mean D and f were not significantly different (P > .05). Soft tissue sarcoma had significantly higher MK than vascular anomalies (P < .05). Areas under curve for ADC, D, MK, and MD were 0.876, 0.885, 0.894, and 0.812, respectively.IVIM and DKI are feasible in discriminating soft tissue sarcoma from vascular anomalies.
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Kuai ZX, Sang XQ, Yao YF, Chu CY, Zhu YM. Evaluation of non-monoexponential diffusion models for hepatocellular carcinoma using b values up to 2000 s/mm 2 : A short-term repeatability study. J Magn Reson Imaging 2018; 50:297-304. [PMID: 30447032 DOI: 10.1002/jmri.26563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Non-monoexponential diffusion models are being used increasingly for the characterization and curative effect evaluation of hepatocellular carcinoma (HCC). But the fitting quality of the models and the repeatability of their parameters have not been assessed for HCC. PURPOSE To evaluate kurtosis, stretched exponential, and statistical models for diffusion-weighted imaging (DWI) of HCC, using b-values up to 2000 s/mm2 , in terms of fitting quality and repeatability. STUDY TYPE Prospective. POPULATION Eighteen patients with HCC. FIELD STRENGTH/SEQUENCE Conventional and DW images (b = 0, 200, 500, 1000, 1500, 2000 s/mm2 ) were acquired at 3.0T. ASSESSMENT The parameters of the kurtosis, stretched exponential, and statistical models were calculated on regions of interest (ROIs) of each lesion. STATISTICAL TESTS The fitting quality was evaluated through comparing the fitting residuals produced on the average data of ROI between different models using a paired t-test or Wilcoxon rank-sum test. Repeatability of the fitted parameters at the median values on the voxelwise data of ROI was assessed using the within coefficient of variation (WCV), the intraclass correlation coefficient (ICC), and the 95% Bland-Altman limits of agreements (BA-LA). The repeatability was divided into four levels: excellent, good, acceptable, and poor, referring to the values of ICC and WCV. RESULTS Among three models, the stretched exponential model provided the best fit to HCC (P < 0.05), whereas the statistical model produced the largest fitting residuals (P < 0.05). The repeatability of K from the kurtosis model was excellent (ICC 0.915; WCV 8.79%), while the distributed diffusion coefficient (DDC) from the stretched model was just acceptable (ICC 0.477; WCV 27.83%). The repeatability was good for other diffusion-related parameters. DATA CONCLUSION Considering the model fit and repeatability, the kurtosis and stretched exponential models are the preferred models for the description of the DW signals of HCC with respect to the statistical model. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:297-304.
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Affiliation(s)
- Zi-Xiang Kuai
- Imaging Center, Harbin Medical University Cancer Hospital, Harbin, P.R. China
| | - Xi-Qiao Sang
- Division of Respiratory Disease, Fourth Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yuan-Fei Yao
- Imaging Center, Harbin Medical University Cancer Hospital, Harbin, P.R. China
| | - Chun-Yu Chu
- College of Engineering, Bohai University, Jinzhou, P.R. China
| | - Yue-Min Zhu
- CREATIS, CNRS UMR 5220-INSERM U1206-University Lyon 1-INSA Lyon-University, Lyon, France
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Hepatic regeneration by associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is feasible but attenuated in rat liver with thioacetamide-induced fibrosis. Surgery 2018; 165:345-352. [PMID: 30249433 DOI: 10.1016/j.surg.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/05/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure promotes the proliferation of the future liver remnant, but evidence to support the feasibility of ALPPS in livers with fibrosis is needed. Therefore the aim of this study was to establish a fibrotic ALPPS model in the rat to compare the capacity of regeneration in the remnant liver with or without fibrosis. METHODS In our study we first established a thioacetamide-induced fibrotic ALPPS model in rats. Then the ALPPS-induced regenerative capacities of normal and fibrotic liver were compared in this animal model. In addition, markers of regeneration, including the proliferative index and cyclin D1 and proliferating cell nuclear antigen levels, as well as various indicators of liver function were determined to evaluate the quality of the hepatic regeneration. RESULTS Compared with that of the sham group (opening of the peritoneal cavity with no further operative manipulation), the proliferation of the future liver remnant in fibrotic rat liver after the ALPPS procedure was increased on postoperative days 1, 2, and 5 (P < .039 each). In addition, the proliferative response was greater in the ALPPS group than in the ligation group subjected only to portal vein ligation of the left lateral, left middle, right, and caudate lobes (P = .099, P = .006, and P = .020 on postoperative days 1, 2, and 5, respectively). In contrast, the ALPPS-induced regenerative capacity in the fibrotic rat livers was attenuated compared with that in the normal liver on postoperative days 1, 2, and 5 (P < .031 for each) after stage I and on postoperative day 5 after stage II of the ALPPS procedure (P < .005). This attenuated the recovery of liver function, and the greater mortality rate indicated that functional proliferation was either delayed or not as extensive in the fibrotic rat livers. CONCLUSION Through establishing a rat model of thioacetamide-induced liver fibrosis, we found that ALPPS-derived liver regeneration was present and feasible in fibrotic livers, but this effect was attenuated compared with that in normal liver.
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Kang D, Schadde E. Hypertrophy and Liver Function in ALPPS: Correlation with Morbidity and Mortality. Visc Med 2017; 33:426-433. [PMID: 29344516 DOI: 10.1159/000479477] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced with the promise to reduce posthepatectomy liver failure (PHLF) in extended hepatectomies but has higher morbidity and mortality rates compared to conventional methods of volume enhancement. There are few studies of the incidence of PHLF after ALPPS and little information on how to avoid PHLF by functional testing. It remains unclear what causes the compromise in liver function despite rapid volume gain and if any of the modifications proposed reduce the incidence of PHLF. This review summarizes published data on this topic. Methods This is a systematic review that studies literature on the incidence of liver failure and assessment of liver function following ALPPS as well as modifications of the existing technique. Articles were searched in PubMed, evaluated, selected, and tabulated. Results The literature search revealed 326 articles that met the selection criteria. PHLF criteria as defined by the International Study Group of Liver Surgery (ISGLS) were the most commonly used criteria, but PHLF was frequently not defined. PHLF occurred most frequently after stage 2 of ALPPS at around 30% in most larger studies. Hepatobiliary scintigraphy showed a discrepancy between volume and functional growth of the liver. Function increase was only 50% compared to volume increase. Mechanistic explanations using histologic analyses have been given to explain the immaturity of the liver after rapid hypertrophy. Modifications of ALPPS showed a comparable volumetric gain when compared to classic ALPPS, but data were lacking to assess PHLF. Conclusion ALPPS has relatively high rates of PHLF, morbidity, and mortality. This may be explained by data demonstrating functional growth when compared to volume growth. ALPPS should not be performed without functional assessment and with caution.
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Affiliation(s)
- Danby Kang
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Erik Schadde
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA.,Cantonal Hospital Winterthur, Winterthur, Switzerland.,Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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