Metabolic dysfunction-Associated fatty liver disease impairs intraoperative indocyanine green fluorescence cholangiography quality: Development and validation of a predictive model.

Abstract

Near-infrared fluorescence cholangiography improves outcomes in laparoscopic cholecystectomy, but it is unknown if metabolic dysfunction-associated fatty liver disease affects indocyanine green fluorescence imaging quality or if this quality can be preoperatively predicted. This study aimed to assess the impact of metabolic dysfunction-associated fatty liver disease on fluorescence quality and to develop a predictive multiple linear regression model. Patients who underwent laparoscopic cholecystectomy between August 2023 and March 2025 were retrospectively analyzed. Participants were divided into training and validation cohorts at a 2:1 ratio using a stratified approach. Fluorescence visualization of biliary structures was assessed through a combination of quantitative fluorescence intensity measurements and qualitative evaluations performed. A regression model was constructed to identify predictors of indocyanine green fluorescence imaging quality. Metabolic dysfunction-associated fatty liver disease was associated with significantly increased liver background fluorescence (P < .05) and reduced common bile duct-to-liver background fluorescence intensity ratio values (P < .01). The duration required to achieve critical division actions was significantly longer in the metabolic dysfunction-associated fatty liver disease group than in the non-metabolic dysfunction-associated fatty liver disease group (P < .05). Hepatic steatosis index, body mass index, and hyperlipidemia were independent predictors of common bile duct-to-liver background fluorescence intensity ratio values, and a regression model was established, with an area under the curve of 0.833 in the training cohort and 0.725 in the validation cohort. Lower predicted fluorescence quality correlated with prolonged duration of critical division actions. Metabolic dysfunction-associated fatty liver disease negatively affects the quality of indocyanine green fluorescence imaging during laparoscopic cholecystectomy by increasing hepatic background fluorescence. The proposed regression model allows preoperative prediction of intraoperative fluorescence quality, supporting tailored indocyanine green administration strategies.