Determination of Pathophysiological Mechanisms of ALPPS in an Animal Model Using Molecular and Functional Imagings

Background: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a two-stage strategy to induce rapid hypertrophy of future liver remnant (FLR) to increase hepatic tumor resectability and reduce postoperative liver failure rate. Rigorous and accurate determination of the pathophysiological mechanisms involved in hypertrophy of FLR in ALPPS is essential to ensure a good success rate in the second stage operation. Methods: : An ALPPS model was established in rabbits with liver VX2 tumor. The pathophysiological mechanisms after the first stage of ALPPS in the FLR and tumor were assessed by multiplexed positron emission tomography (PET) tracers and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). Results: : The tumor volume in the ALPPS model increased significantly from post-stage 1 ALPPS day 14 compared to control animals. The 18 F-FDG uptake increased significantly from day 7 onwards in the ALPPS model. A Valid Volumetric Function measured by 18 F-FCH showed good values in accurately monitoring dynamics and time window for functional liver regeneration (days 3 to 7). DCE-MRI revealed changes in the vascular hyperpermeability function, with a peak on day 7 for tumor and FLR. Conclusions: : Molecular and functional imagings are promising and non-invasive methods to investigate the pathophysiological mechanisms of ALPPS with good potentials in clinical application to improve surgical successful outcomes.