肝切除术后肝功能衰竭（Posthepatectomy liver failure，简称PHLF）是肝切除术的严重并发症。我们旨在基于计算机断层扫描（computed tomography，简称CT）获取的细胞外液体量（extracellular volume，简称ECV）和肝容积测定，开发和验证一个模型，以预测可切除肝细胞癌（hepatocellular carcinoma，简称HCC）患者的术前PHLF。共有来自两家医院的393名可切除HCC患者参与了研究，并在手术前接受了多相增强CT检查。我们医院的281名患者随机划分为训练组（n=181）和内部验证组（n=100），另一家医院的112名患者组成了外部验证组。CT获取的ECV值在无增强和平衡相图像上进行测量，肝容积测定在门静脉期图像上进行测量。该模型由PHLF的独立预测因子组成。使用受试者工作特征曲线下面积（AUC）和校准曲线来反映模型的预测性能和校准情况。使用DeLong检验比较AUC值。CT获取的ECV值、测量的未来肝剩余体积（measured future liver remnant，mFLR）比例和血清白蛋白是可切除HCC患者PHLF的独立预测因子。在训练组、内部验证组和外部验证组中，模型的AUC值均显著高于ALBI评分（均p<0.001）。模型的校准曲线在训练组和内、外部验证组中均显示了良好的一致性。这个新的模型有助于可切除HCC患者术前PHLF的预测。该新模型将CT获取的细胞外液体量、测量的未来肝剩余体积比例和血清白蛋白结合起来，优于白蛋白-胆红素评分，可用于预测可切除肝细胞癌患者的术后肝功能衰竭。• CT获取的ECV值与基础肝脏的纤维化程度相关。• CT获取的ECV值和未来肝剩余体积比例是HCC患者PHLF的独立预测因子。• 该模型的AUC值高于CT获取的ECV值和未来肝剩余体积比例。• 该模型的预测性能优于ALBI评分。© 2023年欧洲放射学会。

Posthepatectomy liver failure (PHLF) is a severe complication of liver resection. We aimed to develop and validate a model based on extracellular volume (ECV) and liver volumetry derived from computed tomography (CT) for preoperative predicting PHLF in resectable hepatocellular carcinoma (HCC) patients.A total of 393 resectable HCC patients from two hospitals were enrolled and underwent multiphasic contrast-enhanced CT before surgery. A total of 281 patients from our hospital were randomly divided into a training cohort (n = 181) and an internal validation cohort (n = 100), and 112 patients from another hospital formed the external validation cohort. CT-derived ECV was measured on nonenhanced and equilibrium phase images, and liver volumetry was measured on portal phase images. The model is composed of independent predictors of PHLF. The under the receiver operator characteristic curve (AUC) and calibration curve were used to reflect the predictive performance and calibration of the model. Comparison of AUCs used the DeLong test.CT-derived ECV, measured future liver remnant (mFLR) ratio, and serum albumin were independent predictors for PHLF in resectable HCC patients. The AUC of the model was significantly higher than that of the ALBI score in the training cohort, internal validation cohort, and external validation cohort (all p < 0.001). The calibration curve of the model showed good consistency in the training cohort and the internal and external validation cohorts.The novel model contributes to the preoperative prediction of PHLF in resectable HCC patients.The novel model combined CT-derived extracellular volume, measured future liver remnant ratio, and serum albumin outperforms the albumin-bilirubin score for predicting posthepatectomy liver failure in patients with resectable hepatocellular carcinoma.• CT-derived ECV correlated well with the fibrosis stage of the background liver. • CT-derived ECV and mFLR ratio were independent predictors for PHLF in HCC. • The AUC of the model was higher than the CT-derived ECV and mFLR ratio. • The model showed a superior predictive performance than that of the ALBI score.© 2023. European Society of Radiology (ESR).