Current risk assessment for post-hepatectomy liver failure (PHLF) is based on the volume of the future liver remnant (FLR). This is inaccurate when liver function is inhomogeneously distributed. We investigated whether the function of the FLR measured with DCE-MRI improves outcome predictions in 28 patients who had curative resection for colorectal liver metastases. We found the difference in preoperative estimates of FLR function and volume predicted PHLF with a sensitivity of 83% and specificity of 91%, indicating that: (1) inhomogeneous distribution of function is a major risk factor for PHLF; (2) DCE-MRI can improve patient outcome by correcting for the bias caused by volumetry.
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