Functional Assessment by Gd-EOB-MRI of the Future Liver Remnant Predicts Posthepatectomy Liver Failure: A Systematic Review and Meta-Analysis
Abstract
Background & Aims: Posthepatectomy liver failure (PHLF) is a major cause of morbidity and mortality following liver resection. Accurate preoperative prediction of posthepatectomy liver failure (PHLF) remains a clinical challenge. Gadoxetic acid-enhanced MRI (Gd-EOB-MRI) enables quantitative assessment of liver function. This systematic review and meta-analysis aims to determine the diagnostic accuracy of Gd-EOB-MRI quantitative parameters for predicting PHLF and to explore sources of heterogeneity. Methods: A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted from January 2011 to June 2025 for studies evaluating Gd-EOB-MRI parameters for PHLF prediction in adults undergoing hepatectomy. The bivariate random-effects model was used to calculate the pooled area under the curve (AUC). Heterogeneity was assessed using the I² statistic. Subgroup, threshold effect, and publication bias analyses were performed. Results: Nineteen studies involving 3,658 patients were included. Future liver remnant (FLR)-based parameters (14 studies) demonstrated high diagnostic accuracy with a pooled AUC of 0.85 (95% CI: 0.82–0.89) and moderate heterogeneity (I² = 27.9%). Whole liver-based parameters (7 studies) also showed good performance (pooled AUC = 0.80, 95% CI: 0.76–0.84). Subgroup analyses revealed no significant differences based on MRI parameters, study design, region, sample size, or PHLF definition. However, studies using 3.0T MRI scanners showed a significantly higher pooled AUC than those using 1.5T (0.859 vs. 0.763, p=0.018). A significant threshold effect was observed for FLR parameters (Spearman's ρ = 0.744, p=0.006) but not for whole liver parameters. No significant publication bias was detected. Conclusions: FLR-based Gd-EOB-MRI parameters provide excellent diagnostic performance for predicting PHLF, outperforming to whole liver-based assessment. This supports the integration of functional FLR assessment into preoperative risk stratification. However, the presence of a threshold effect underscores the need for standardized protocols and validated diagnostic cut-offs in future prospective multicenter studies. Prospective multicenter studies with standardized protocols and predefined diagnostic thresholds are needed to validate these findings and facilitate clinical translation.
Keywords
Citation Information
@article{yannanliu2026,
title={Functional Assessment by Gd-EOB-MRI of the Future Liver Remnant Predicts Posthepatectomy Liver Failure: A Systematic Review and Meta-Analysis},
author={Yannan Liu and Xiaolei Shi},
journal={Abdominal Radiology},
year={2026},
doi={https://doi.org/10.21203/rs.3.rs-9333721/v1}
}
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