Intravoxel Incoherent Motion and Dynamic Contrast Enhanced Quantitative Magnetic Resonance Imaging in the Preoperative Evaluation of Liver Function

Abstract

Background: Surgical removal of liver tumors necessitates a thorough preoperative assessment to ensure adequate future liver remnant function, which is crucial for hepatic regeneration. Imaging techniques like hepatobiliary scintigraphy (HBS) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) assess liver function by measuring the uptake of liver-specific contrast agents. Intravoxel incoherent motion (IVIM)-MRI measures both molecular diffusion and perfusion-related motion of water molecules in the liver. This provides valuable insights into tissue microenvironment changes that can indicate liver dysfunction. However, the potential of IVIM-MRI in this context remains unexplored. This study aims to evaluate the feasibility of IVIM-MRI for liver function assessment and its relationship with DCE MRI. Methods: Twenty-one patients scheduled for major hepatectomy underwent preoperative assessment involving HBS, a 20-minute DCE-MRI series, and IVIM-MRI with 15 b-values. DCE-MRI parameters (hepatocyte uptake Ki(min−1), arterial plasma flow Fa (mL/min/100 mL), and venous plasma flow Fv (mL/min/100 mL)), were analyzed using the Sourbron model. IVIM-MRI parameters (diffusion D (mm2/s), pseudo-diffusion Dp (mm2/s), and perfusion fraction f (%)) were extracted using a UNET model developed at Amsterdam University Medical Centers. Correlation between parameters was assessed using Pearson correlation analysis. Furthermore, Blant-Altman was employed to assess the inter-observer variability and the reproducibility of the DCE-MRI parameters. Results: In 19 patients, weak correlations were observed between DCE- and IVIM-MRI parameters, with correlation coefficients ranging from r = −0.326 to r = 0.443. Despite the lack of significant correlations between these parameters, strong correlations were observed between DCE-MRI Ki and HBS (r = 0.80, p < 0.001). Moreover, DCE-MRI parameters demonstrated high reproducibility, with Bland-Altman mean biases ranging from -1.79 to -0.08. Conclusion: The weak correlation observed between DCE- and IVIM-MRI parameters suggests that IVIM-MRI may have limited utility in preoperative liver function assessment. Nevertheless, DCE-MRI may serve as an alternative to HBS, potentially providing a one-stop shop for preoperative liver assessment with MRI. Further research is necessary to explore its potential in diverse populations with varying liver function.