Uncertain outcome of liver surgery
Many malignant liver diseases are diagnosed when they are in an advanced stage and the liver may be seriously damaged. At that time, surgery or liver transplantation is often the only curable treatment option. In order for the patient to survive a liver tumor operation, a healthy piece of the liver has to be left in the body. The liver is then growing during 4-5 weeks to regain almost full size and function. The first week after the surgery is a critical time since the small sized liver has to manage the job of a full liver.
Today, determination of how much of the liver to remove is difficult as only a rough estimate of the liver function can be made. Occasionally, patients may suffer from liver failure following radical surgery. On the other hand, some patients are wrongly judged unfit for surgery when the rough estimate suggests that they will not survive the procedure. With a better estimate of size and function in the liver residue more patients could be surgical candidates.
MR technology improves the diagnostic precisionWith the help of MR it is possible to measure several parameters in the liver without invasive procedures. The MR also enables a better overview of the liver status as a whole compared to biopsies, as they only show status at the location where the sample is taken. If the biopsy is extracted from the wrong area there is a risk that important information is overlooked.
The magnetic resonance technology may, among other things, be used to measure the amount of fat in the liver, measure the uptake of a contrast agent to get an idea of how well the liver works and measure levels of many different elements, including iron and phosphorus compounds. The research group has developed multimodal methods for analyzing the liver.
The MR protocol for analyzing the liver status is now ready to be tested in the workflow at other hospitals. This is an important step in showing that our method is ready for routine use. Health economists will then analyze if the method has an economical value, or may increase the quality of care.
Vibrations find fibrosis
One of the MR methods used is elastography. The examination shows fibrosis, formation of connective tissue, in the liver. The connective tissue makes the liver less flexible and impairs its normal elasticity. During MR mechanical vibrations are sent into the patient´s body. The vibrations are propagated differently depending on the flexibility of the tissue. Through registration of the different vibrations the MR-scanner can separate healthy from diseased tissue regions.
Together with the CMIV spinoff AMRA AB we are developing a tool where data from different types of liver measurements may be gathered. The data will support the physician in determine how to treat the patient. Apart from MR data the tool will also be able to collect other types of information. In line with this the project is investigating the possibility to use digital pathology in analyzing the biopsies and instead of a visual examination use image analysis to obtain a value of for example fat infiltration.