Novel multimetric MRI detects improved future liver remnant quality post-dual vein embolization

Background Optimisation of the future liver remnant (FLR) is crucial to outcomes of extended liver resections. This study aimed to assess the quality of the FLR before and after dual vein embolization (DVE) by multiparametric MRI. Methods Of 100 patients with liver metastases recruited in a clinical trial (Precision1:NCT04597710), ten consecutive patients with insufficient FLR underwent multiparametric MRI (Hepatica®) pre- and post-DVE (right portal and hepatic vein). FLR volume, liver fibro-inflammation (corrected T1) scores and fat percentage (proton density fat fraction, PDFF) were determined. Patient metrics were compared by Wilcoxon signed-rank test and statistical analysis done using R software. Results All patients underwent uncomplicated DVE with improvement in liver remnant health, median 37 days after DVE: cT1 scores reduced from median(interquartile range) 790 ms(753-833 ms) to 741 ms(708-760 ms) p=0.014 [healthy range <795 ms], as did PDFF from 11%(4-21%), to 3%(2-12%) p=0.017 [healthy range <5.6%]. There was a significant increase in median(interquartile range) FLR volume from 33%(30-37%)% to 49%(44-52%), p=0.002. Conclusion This non-invasive and reproducible MRI technique showed improvement in volume and quality of the FLR after DVE. This is a significant advance in our understanding of how to prevent liver failure in patients undergoing major liver surgery.