• Indocyanine green retention test
• Liver cancer
• Liver function assessment
• Post-hepatectomy liver failure
• Risk assessment

• chronic liver disease
• diagnostic tests
• hepatology
• liver cirrhosis
• liver fibrosis
• liver function

• indocyanine green-imaging
• liver fibrosis
• liver toxicity
• oxidative stress
• quinazoline

This study aimed to investigate the value of contrast-enhanced ultrasound (CEUS) for preoperative assessment of liver reserve function in patients with liver tumors. The indocyanine green (ICG) clearance tests and CEUS examinations of 45 noncirrhotic patients with liver tumors were performed prior to liver resection. Parameters time to peak (TtoPk), arrival time (Atm) as well as perfusion parameters A, k and A x k were generated from time-intensity curve (TIC) of CEUS. The correlation analyses of the ICG clearance per unit time (ICGK) and the retention rate at 15 min (ICGR15) with TtoPk, Atm, A, k and A x k were performed, and the diagnostic ability as well as optimal cut-off values of TtoPk and Atm for differentiating patients with ICGR15>10% from ICGR15<10% were analyzed. There were significant correlations of ICGK with TtoPk and Atm, and the correlation coefficients were 0.363 (p = 0.014) and -0.482 (p = 0.001), respectively. Significant correlations of ICGR15 with TtoPk and Atm were revealed, and the correlation coefficients were -0.416 (p = 0.004) and 0.303 (p = 0.043), respectively. No correlation of ICGK or ICGR15 with A, k and A x k was found in this study. There were significant differences in TtoPk and Atm between patients with ICGR15>10% and ICGR15<10% (p = 0.028 and p = 0.026, respectively). TtoPk and Atm both had good diagnostic abilities in diagnosing patients with ICGR15>10% verusus ICGR15<10% (AUROC = 0.711 and 0.721, respectively). For ICGR15>10% vs ICGR15, the optimal cut-off values of TtoPk and Atm were 13.307 s and 11.007 s, respectively, while the sensitivity and specificity were 75.0% and 72.7%, 60.6% and 75.0%, respectively. This study revealed that CEUS has the potential to be a new method to evaluate the liver reserve function of patients. With the optimal cut-off values of TtoPk and Atm, qualitative assessment of patients with ICGR15>10% could be more easily achieved by CEUS with good diagnostic abilities.

• Adult
• Aged
• Coloring Agents/administration & dosage
• Contrast Media/administration & dosage
• Female
• Hepatectomy/methods
• Humans
• Indocyanine Green/administration & dosage
• Liver/physiopathology
• Liver/surgery
• Liver Function Tests/methods
• Liver Neoplasms/diagnosis
• Liver Neoplasms/physiopathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Perfusion/methods
• ROC Curve
• Sensitivity and Specificity
• Ultrasonography/methods

• MELD score
• abdomen
• liver
• magnetic resonance imaging
• multiparametric examination

• Abdominal surgery
• Indocyanine green
• Intra-abdominal hypertension
• Liver dysfunction

• APACHE
• Abdomen/physiopathology
• Abdomen/surgery
• Adult
• Aged
• Coloring Agents/pharmacology
• Croatia
• Female
• Humans
• Indocyanine Green/pharmacology
• Intra-Abdominal Hypertension/blood
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/etiology
• Liver/physiopathology
• Liver Diseases/blood
• Liver Diseases/diagnosis
• Liver Diseases/etiology
• Liver Function Tests/methods
• Male
• Middle Aged
• Postoperative Complications/blood
• Postoperative Complications/diagnosis
• Prognosis
• Prospective Studies
• Surgical Procedures, Operative/adverse effects
• Surgical Procedures, Operative/methods

• Biliary atresia
• OK-432
• indocyanine green clearance test
• liver function

• Child–Pugh class
• DWI
• Intravoxel incoherent motion
• Liver function

The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis.

• Liver resection
• Hepatocellular carcinoma
• Liver metastases
• Portal hypertension
• Cholangiocellular carcinoma
• Cirrhosis

• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/etiology
• Carcinoma, Hepatocellular/surgery
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Hypertension, Portal/diagnosis
• Hypertension, Portal/etiology
• Hypertension, Portal/physiopathology
• Hypertension, Portal/surgery
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/surgery
• Liver Neoplasms/diagnosis
• Liver Neoplasms/etiology
• Liver Neoplasms/surgery
• Liver Transplantation
• Patient Selection
• Portal Pressure
• Portasystemic Shunt, Transjugular Intrahepatic
• Postoperative Complications/etiology
• Predictive Value of Tests
• Risk Factors
• Treatment Outcome

AIM: To evaluate the utility of liver reserve function by acoustic radiation force impulse (ARFI) imaging in patients with liver tumors.

METHODS: Seventy-six patients with liver tumors were enrolled in this study. Serum biochemical indexes, such as aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin (ALB), total bilirubin (T-Bil), and other indicators were observed. Liver stiffness (LS) was measured by ARFI imaging, measurements were repeated 10 times, and the average value of the results was taken as the final LS value. Indocyanine green (ICG) retention was performed, and ICG-K and ICG-R15 were recorded. Child-Pugh (CP) scores were carried out based on patient’s preoperative biochemical tests and physical condition. Correlations among CP scores, ICG-R15, ICG-K and LS values were observed and analyzed using either the Pearson correlation coefficient or the Spearman rank correlation coefficient. Kruskal-Wallis test was used to compare LS values of CP scores, and the receiver-operator characteristic (ROC) curve was used to analyze liver reserve function assessment accuracy.

RESULTS: LS in the ICG-R15 10%-20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.19 ± 0.27 vs 1.59 ± 0.32, P < 0.01). LS in the ICG-R15 > 20% group was significantly higher than in the ICG-R15 < 10% group; and the difference was statistically significant (2.92 ± 0.29 vs 1.59 ± 0.32, P < 0.01). The LS value in patients with CP class A was lower than in patients with CP class B (1.57 ± 0.34 vs 1.86 ± 0.27, P < 0.05), while the LS value in patients with CP class B was lower than in patients with CP class C (1.86 ± 0.27 vs 2.47 ± 0.33, P < 0.01). LS was positively correlated with ICG-R15 (r = 0.617, P < 0.01) and CP score (r = 0.772, P < 0.01). Meanwhile, LS was negatively correlated with ICG-K (r = -0.673, P < 0.01). AST, ALT and T-Bil were positively correlated with LS, while ALB was negatively correlated with LS (P < 0.05). The ROC curve revealed that the when the LS value was 2.34 m/s, the Youden index was at its highest point, sensitivity was 69.2% and specificity was 92.1%.

CONCLUSION: For patients with liver tumors, ARFI imaging is a useful tool for assessing liver reserve function.

• Acoustic radiation force impulse
• Liver reserve function
• Liver tumor
• Receiver-operator characteristic

• Adult
• Aged
• Area Under Curve
• Biomarkers, Tumor/blood
• Catheter Ablation
• Elasticity Imaging Techniques
• Embolization, Therapeutic
• Female
• Fluorescent Dyes/administration & dosage
• Hepatectomy
• Humans
• Indocyanine Green/administration & dosage
• Liver Function Tests
• Liver Neoplasms/blood
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Reproducibility of Results

AIM: To evaluate the role of the ¹³C-methacetin breath test (¹³C-MBT) in the assessment of acute liver injury in a rat model.

METHODS: Acute liver injury in rats was induced by a single intraperitoneal injection of D-galactosamine (D-GalN). Forty-eight male Sprague-Dawley rats were randomly assigned to a control group (n = 8) and five model groups (each n = 8), and acute liver injury was assessed at different time points (6, 12, 24, 48 and 72 h) after D-GalN injection. The ¹³C-MBT, biochemical tests, 15-min retention rate of indocyanine green (ICG_R15), and liver biopsy were performed and compared between the control and model groups. Correlations between parameters of the ¹³C-MBT (T_max, MV_max, CUM₁₂₀ and DOB_max), biochemical tests, ICG_R15 and liver necrosis score were also analyzed using Spearman’s correlation analysis.

RESULTS: T_max, MV_max, CUM₁₂₀ and DOB_max, as well as most of the traditional methods, correlated with the liver necrosis score (r = 0.493, P < 0.05; r = -0.731, P < 0.01; r = -0.618, P < 0.01; r = -0.592, P < 0.01, respectively). MV_max, CUM₁₂₀ and DOB_max rapidly decreased and were lower than those in the controls as early as 6 h after D-GalN injection (3.84 ± 0.84 vs 5.06 ± 0.78, P < 0.01; 3.35 ± 0.72 vs 4.21 ± 1.44, P < 0.05; 52.3 ± 20.58 vs 75.1 ± 9.57, P < 0.05, respectively) and reached the lowest point 24 h after D-GalN injection. MV_max, CUM₁₂₀ and DOB_max returned to normal levels 72 h after D-GalN injection and preceded most of the traditional methods, including liver biopsy.

CONCLUSION: The ¹³C-MBT is a sensitive tool for the timely detection of acute liver injury and early prediction of recovery in a rat model. Further clinical studies are warranted to validate its role in patients with acute liver injury.

• ¹³C-methacetin breath test
• Acute liver injury
• Liver function
• Animal model

• Acute Disease
• Animals
• Biomarkers/metabolism
• Biopsy
• Breath Tests/methods
• Carbon Dioxide/metabolism
• Carbon Isotopes/pharmacokinetics
• Chemical and Drug Induced Liver Injury/diagnosis
• Chemical and Drug Induced Liver Injury/etiology
• Chemical and Drug Induced Liver Injury/metabolism
• Chemical and Drug Induced Liver Injury/pathology
• Disease Models, Animal
• Fluorescent Dyes
• Galactosamine
• Indocyanine Green
• Liver/metabolism
• Liver/pathology
• Male
• Oxyphenonium/pharmacokinetics
• Rats, Sprague-Dawley