Surgery Clinical Trial
Official title:
HepaT1ca: Quantifying Liver Health in Surgical Candidates for Liver Malignancies
This observational clinical cohort study aims to evaluate the clinical utility of LiverMultiScan in quantifying liver health prior to liver resection or TACE. The results will enable further developments in scanning protocols and software, and clearly define the relevance of applying this technology as part of the pre-operative assessment of the patient being considered for liver resection or TACE.
The liver is unique among the abdominal organs for the capacity to regenerate
post-operatively. However, a minimum functional liver remnant (FLR) is required for patients
to survive the initial perioperative period. At present, the assessment of the FLR is based
on volume alone, in the context of clinical judgment and surrogate markers of liver function
based on blood tests. Recently, Perspectum Diagnostics have developed and validated
LiverMultiScan, an MRI-based technology that can non-invasively quantify fibroinflammatory
disease in addition to steatosis and iron content. In this project, we plan to use
LiverMultiScan as an additional direct measurement of liver health prior to resectional
surgery or transarterial chemoembolization (TACE), so that liver volume and function can be
combined. For example, surgery with a predicted FLR of 21% might be survivable if the liver
tissue was in extremely good health, whereas surgery with a predicted FLR of 40% might be
lethal if the liver tissue was in poor health. Occasionally, portal vein embolization (PVE)
is performed to promote hypertrophy of the FLR. Furthermore, non-resectional intervention,
for example TACE for primary liver cancers, is well-tolerated by patients with healthy
livers, but can lead to serious liver decompensation and liver failure if TACE is delivered
to a liver in poor health. Currently, the available imaging modalities are limited in their
ability to assess liver health in liver resection or TACE candidates. Liver fat content
(steatosis) can be assessed with CT, or more accurately with MRI. However, fibroinflammatory
disease, which has been shown to correlate with post-resection morbidity, typically requires
an invasive biopsy to diagnose accurately.
This research project will support the definition, development and technical validation of
Hepatica, which aims to build on the MRI technology underlying LiverMultiScan and develop the
additional functionality required to meet this clinical need.
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