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Quantitative liver function imaging and whole genome sequencing – Effective modalities for a new era in personalised decision-making for operable colorectal liver metastases?
Welsh, Fenella Sundaravadanan, Senthil Sethi, Pulkit Kazeroun, Mohammad Fichera, Alessandro Nadziruddin, Irdina Larkin, Sarah J. Ansari-Pour, Naser Maughan, Tim Brady, Michael
Welsh, Fenella
Sundaravadanan, Senthil
Sethi, Pulkit
Kazeroun, Mohammad
Fichera, Alessandro
Nadziruddin, Irdina
Larkin, Sarah J.
Ansari-Pour, Naser
Maughan, Tim
Brady, Michael
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Computer Vision
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Journal article
Date
2025
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English
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Abstract
Background: The optimal strategy for patients with colorectal liver metastases (CRLM) is unclear. The Precision1 prospective, observational trial assessed whether pre-operative functional imaging and whole genome sequencing (WGS), could enhance individualized decision-making. Methods: Patients with CRLM considered for hepatectomy were recruited. In addition to standard staging, patients underwent a quantitative multiparametric MRI (mpMRI) scan, to assess liver function. Use of mpMRI to aid surgical decision-making, was prospectively recorded, as were short-term clinical outcomes in patients who underwent hepatectomy. In the first 45 patients, WGS was performed on blood and liver tumour samples collected per-operatively. Results: 95 mpMRI scans were performed in 84 patients, who underwent 87 resections. The mpMRI scan affected surgical decision-making in 41 % (39/95) of scans, with 11 undergoing dual-vein embolization, 16 undergoing more conservative parenchymal-sparing surgery, 11 having more extensive surgery, and one patient following a low calorie diet pre-operatively. There were significant (Clavien-Dindo grades 3/4) complications in 5 % of patients, no Grade C post-hepatectomy liver failure, and zero 90-day mortality. WGS suggested additional therapeutic options and prognostic factors for 22 of 35 (63 %) evaluable patients. Conclusion: Precision1 shows mpMRI can aid surgical decision-making, and optimise clinical outcomes. WGS provides additional information, to further enhance personalised decision-making. © 2025 The Authors
Citation
F. Welsh et al., “Quantitative liver function imaging and whole genome sequencing – Effective modalities for a new era in personalised decision-making for operable colorectal liver metastases?,” HPB, vol. 27, no. 4, pp. 553–561, Apr. 2025, doi: 10.1016/J.HPB.2024.12.023
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HPB
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Elsevier