HPB P68 Multimetric MRI detects improved quality of the future liver remnant post-dual vein embolization – a novel finding

Abstract Background Optimisation of the future liver remnant (FLR) is crucial to the safety of extended liver resections. This study aimed to assess volume and quality of the FLR pre- and post-dual vein embolisation (DVE) by MRI, in patients with insufficient FLR, needing major hepatectomy. Methods Of 81 patients recruited in a clinical trial (Precision1:NCT04597710), seven consecutive patients with colorectal liver metastases underwent multiparametric MRI (Hepatica®) pre- and post-DVE (right hepatic and portal vein). One patient had DVE after a first-stage hepatectomy. FLR volume, fibro-inflammation map (corrected T1) and fat (proton density fat fraction, PDFF) was determined. Results All 7 patients underwent uncomplicated DVE, with significant increase in median(range) %FLR volume at liver surgery [45.7(27.0–57.8)% versus 32.4 (19.5–37.7)%, p=0.016], 46 days (range 28–77) post-DVE. Median(range) FLR cT1 scores reduced post-DVE [747.33 (684–884)ms, versus 771.25(726–945)ms, p=0.047; healthy range<794ms], as did median(range) PDFF scores [3.4 (2–13.25)% versus 6 (1.5–22.5)%, p=0.078; healthy range <5.6%]. No patient developed post-hepatectomy liver failure (PHLF). Conclusions This novel, non-invasive and readily accessible MRI technique shows that volume and quality of the FLR improves after DVE. This is a significant step in improving surgical decision making in patients with borderline FLR, preventing PHLF and improving outcomes.