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• Clinical Article •
Skewness on gadoxetic acid-enhanced MRI histogram: A potent predictor of post-hepatectomy liver failure in hepatocellular carcinoma
QI Tingyu  ZHU Shaocheng 

DOI:10.12015/issn.1674-8034.2026.05.012.


[Abstract] Objective Based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging to obtain conventional signal intensity histogram features of hepatobiliary phase images, preoperatively evaluating its diagnostic performance for post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma.Materials and Methods A retrospective study was performed at a single center. Information was gathered from 198 individuals diagnosed with hepatocellular carcinoma and who had hepatectomy at Henan Provincial People's Hospital from January 2017 to December 2023. Each patient included in the study had preoperative Gd-EOB-DTPA enhanced MRI scans. Based on the PHLF diagnostic criteria formulated by the International Study Group of Liver Surgery (ISGLS), the patients were categorized into a PHLF group (42 cases) and a non-PHLF group (156 cases). The preoperative hepatobiliary phase histogram parameters were compared between the PHLF group and non-PHLF group, and receiver operating characteristic (ROC) curves were employed to assess how well these histogram parameters could predict the likelihood of developing liver failure after hepatectomy.Results The PHLF group showed significantly higher kurtosis, mean, mean deviation, skewness, 10th percentile, and 90th percentile values compared with the non-PHLF group (Bonferroni corrected P < 0.003 3). The ROC analysis indicated that the area under the curve (AUC) for skewness in predicting postoperative PHLF was 0.868 [95% confidence interval (CI): 0.809 to 0.928], while the AUCs for the 10th percentile, kurtosis, and mean were 0.720 (95% CI: 0.632 to 0.807), 0.665 (95% CI: 0.570 to 0.760), and 0.657 (95% CI: 0.559 to 0.754), respectively. Skewness demonstrated the best predictive performance with an AUC of 0.868, sensitivity of 69.0%, specificity of 89.1%, and an optimal cutoff value of 0.515.Conclusions Conventional signal intensity histogram analysis of Gd-EOB-DTPA enhanced MRI hepatobiliary phase images, particularly the skewness parameter, can serve as an effective imaging tool for preoperative prediction of PHLF in HCC, but it needs to be comprehensively assessed in combination with clinical factors such as the extent of surgical resection and the future residual liver volume.
[Keywords] hepatocellular carcinoma；liver failure；Gd-EOB-DTPA-enhanced；magnetic resonance imaging；liver resection；hepatobiliary phase histogram analysis

QI Tingyu1   ZHU Shaocheng1, 2, 3*  

1 Department of Imaging, Henan Medical University, Henan Provincial People's Hospital, Xinxiang 453003, China

2 Department of Imaging, Henan Provincial People's Hospital, Zhengzhou 450003, China

3 Department of Imaging, Fuwai Central China Cardiovascular Hospital, Zhengzhou 450003, China

Corresponding author: ZHU S C, E-mail: zsc2686@163.com

Conflicts of interest   None.

Received  2025-12-23
Accepted  2026-04-28
DOI: 10.12015/issn.1674-8034.2026.05.012
DOI:10.12015/issn.1674-8034.2026.05.012.

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