Preoperative Determination of the Surgical Procedure for Hepatectomy Using Technetium–99M–Galactosyl Human Serum Albumin (99MTc–Gsa) Liver Scintigraphy

Abstract

differences are thought to depend mainly on the effective Technetium-99m-diethylenetriaminepentaacetic acidhepatic blood flow and the intra-, extrahepatic shunt. galactosyl human serum albumin (Tc-GSA) is a new liverAshwell and Morell demonstrated the existence of a hepatic scintigraphy agent which binds to the asialoglycoprobinding receptor for asialoglycoproteins (ASGP) with the intein receptors. We evaluated the preoperative assessvestigation of ceruloplasmin metabolism. 6 They found that ment for hepatectomy using Tc-GSA liver scintigraphy.ceruloplasmin molecules, which lack a sialic acid residue, Ninety patients with hepatocellular carcinoma were adrapidly disappeared from the circulation and were taken up mitted for elective hepatectomy. Tc-GSA scintigraphy by hepatocytes. 7 This activity was found to be exclusively was conducted after the intravenous injection of Tcassociated with a protein termed ASGP receptors (ASGPR) GSA, and maximal removal rate of Tc-GSA (GSA-Rmax)in the sinusoidal membrane of hepatocytes. 8 Sawamura et was calculated using a radiopharmacokinetic model. al. 9 reported that a decrease in the number of ASGPRs led Measurement of GSA-Rmax, conventional liver function, to the accumulation of ASGP in the sera of galactosamineand 15-minute retention rate of indocyanine green treated rats. In addition, this receptor decreases in patients (ICGR15) was carried out preoperatively. The relationwith chronic liver disease. 10ships between liver functions, histological activity index Technetium-99m-diethylenetriaminepentaacetic acid-ga-(HAI), ICGR15, and GSA-Rmax values were estimated. A lactosyl, human serum albumin (Tc-GSA), is a new liver scinsignificant correlation was obtained between GSA-Rmax tigraphy agent which binds to the ASGPR on hepatocytes. and ICGR15 (r Å .534, P õ .0001). Preoperative discrepanMaximal removal rate of Tc-GSA (GSA-Rmax) using a radiocies between GSA-Rmax and ICGR15 values were seen pharmacokinetic model decreased with the severity of liver in 15 patients. In these cases, the GSA-Rmax values cordisease, and there was also a significant difference in the related well with the total HAI scores (r Å .595, P õ .02), GSA-Rmax between the chronic hepatitis and normal liver but no significant correlation was seen between the groups. 11 The purpose of this study was to evaluate the clini-ICGR15 and HAI scores. Two patients died of postoperacal utility of the GSA-Rmax for the preoperative assessment tive liver failure within 2 months of the operation. These of hepatectomy in patients with hepatocellular carcinoma. 1992 and December 1995. The mean age of all patients was 61 years, with a range of 43 to 77 years. There were 72 (80%) male and 18 (20%) female patients, yielding a male:female ratio of 4:1; 59 patients It is well known that patients with a normal liver tolerate (65.6%) had cirrhosis. Surgical resections were performed according a 70% to 80% hepatectomy and that regeneration of the liver to the liver anatomy of Couinaud.12 Surgical procedures were mainly determined usi...

Correlation of liver parenchymal gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid enhancement and liver function in humans with hepatocellular carcinoma

“…Our findings in patients with hepatitis confirmed the results of Kim et al and the physiological mechanism of Gd-EOB-DTPA. The prognosis of patients with cirrhosis and HCC depends on residual liver function and tumor extension (23,24). Various prognostic staging systems for HCC combine the Child-Pugh liver function classification with tumor extension (23,24).…”

“…The prognosis of patients with cirrhosis and HCC depends on residual liver function and tumor extension (23,24). Various prognostic staging systems for HCC combine the Child-Pugh liver function classification with tumor extension (23,24). The preoperative assessment of functional reserve is significant for estimating the extent of hepatectomy.…”

“…The preoperative assessment of functional reserve is significant for estimating the extent of hepatectomy. Hepatic functional reserve is widely assessed using the ICG test, but technetium-99m-galactosyl human serum albumin liver scintigraphy appears to be equally effective for selecting candidates for hepatectomy (23,24). Findings of the current study have shown that Gd-EOB-DTPA-enhanced MRI findings correlated with total bilirubin values and ICG-R15, and that this modality has potential for use in the same manner as scintigraphy as a prognostic staging system and as a parameter for the preoperative assessment of hepatectomy.…”

Index of convexity: A novel method for assessing liver functional reserve using technetium-99m-galactosyl human serum albumin liver scintigraphy

“…Technetium-99m diethylenetriamine-penta-acetic acid-galactosyl human serum albumin ( 99m Tc-GSA) scintigraphy is one of the prevalent examinations performed for evaluation of liver functional reserve (17)(18)(19)(20)(21)(22)(23)(24)(25). Conventional indices of 99m Tc-GSA scintigraphy, namely the blood clearance index (HH15) and the receptor index (LHL15), use accumulation counts of only two time points.…”

Prediction of Indocyanine Green Retention Rate at 15 Minutes by Correlated Liver Function Parameters before Hepatectomy

“…Recently, a new test that reliably assesses hepatic functional reserve, technetium-99m galactosyl human serum albumin ( 99m Tc-GSA) scintigraphy, has been used in patients with liver diseases [13,14]. This test is based on the fact that asialoglycoprotein receptors on hepatocytes reflect functional liver cells [15] and are not influenced by vascular shunt or obstructive jaundice [16,17].…”