Gaspard d'Assignies1, Cindy Fayard1, Helena Leitao1, Toni Alfaiate2, Florence Tubach3, Safi Dokmak4, Valérie Paradis5, Bernard E Van Beers1, Maxime Ronot6, Valérie Vilgrain1. 1. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. 2. Département d'Epidémiologie et Recherche Clinique, APHP, University Hospitals Paris Nord Val de Seine, Bichat, Paris, France; INSERM CIC 1425-EC, UMR 1123 ECEVE, Paris, France. 3. University Paris Diderot, Sorbonne Paris Cité, Paris, France; Département d'Epidémiologie et Recherche Clinique, APHP, University Hospitals Paris Nord Val de Seine, Bichat, Paris, France; INSERM CIC 1425-EC, UMR 1123 ECEVE, Paris, France. 4. Department of Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. 5. University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France; Department of Pathology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. 6. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. Electronic address: maxime.ronot@bjn.aphp.fr.
Abstract
BACKGROUND: Steatosis assessed by histology is commonly considered to be a significant risk factor for liver surgery. MRI is considered as the new gold standard for noninvasive liver fat quantification. The purpose was to assess whether liver steatosis determined by preoperative MRI is an independent risk factor of complications after major liver resection. METHODS: All patients who underwent liver MRI before major liver resection in our institution between January 2001 and December 2011 were included in this retrospective study. The liver fat fraction (LFF) was assessed on in- and opposed-phase T1-weighted dual echo gradient echo MRI and steatosis was defined as a MRI LFF of ≥ 5%. The association between steatosis and postoperative complications (Clavien-Dindo classification, ascites > 500 mL at day 5, 50-50 criteria, fistula/collection, blood liver test alterations, pulmonary complications, nonpulmonary complications, >1 complication, duration of stay in the intensive care unit, duration of hospital stay, and death) was assessed by multivariate analysis using the appropriate model. RESULTS: A MRI LFF of ≥ 5% was associated with severe postoperative complications (Clavien-Dindo score ≥ IIIa; P = .04), more pulmonary complications (P = .02), and longer duration of hospital stay (P = .02) on the multivariate model adjusted for confounding factors. The postoperative aminotransferase levels were higher in patients with a MRI LFF of ≥ 5%, than in other patients (P = .0008). CONCLUSION: Liver steatosis assessed by routine preoperative MRI is shown to be an independent risk factor of severe postoperative complications after major liver resection.
BACKGROUND:Steatosis assessed by histology is commonly considered to be a significant risk factor for liver surgery. MRI is considered as the new gold standard for noninvasive liver fat quantification. The purpose was to assess whether liver steatosis determined by preoperative MRI is an independent risk factor of complications after major liver resection. METHODS: All patients who underwent liver MRI before major liver resection in our institution between January 2001 and December 2011 were included in this retrospective study. The liver fat fraction (LFF) was assessed on in- and opposed-phase T1-weighted dual echo gradient echo MRI and steatosis was defined as a MRI LFF of ≥ 5%. The association between steatosis and postoperative complications (Clavien-Dindo classification, ascites > 500 mL at day 5, 50-50 criteria, fistula/collection, blood liver test alterations, pulmonary complications, nonpulmonary complications, >1 complication, duration of stay in the intensive care unit, duration of hospital stay, and death) was assessed by multivariate analysis using the appropriate model. RESULTS: A MRI LFF of ≥ 5% was associated with severe postoperative complications (Clavien-Dindo score ≥ IIIa; P = .04), more pulmonary complications (P = .02), and longer duration of hospital stay (P = .02) on the multivariate model adjusted for confounding factors. The postoperative aminotransferase levels were higher in patients with a MRI LFF of ≥ 5%, than in other patients (P = .0008). CONCLUSION:Liver steatosis assessed by routine preoperative MRI is shown to be an independent risk factor of severe postoperative complications after major liver resection.