Separate Analysis of Asialoglycoprotein Receptors in the Right and Left Hepatic Lobes Using 99MTc–Gsa Spect

Abstract

The asialoglycoprotein receptor (ASGPR) is abundantly expressed on the sinusoidal surfaces of hepatocytes. We aimed to clarify the clinical significance of the regional distribution of ASGPRs in the human liver, especially in chronic viral hepatitis. Eighteen volunteers, 34 patients with chronic hepatitis, and 33 patients with cirrhosis (11/Child-Pugh A, 11/Child-Pugh B, 11/Child-Pugh C) were studied using a newly developed, conventional technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin ((99m)Tc-GSA), single photon emission computed tomography (SPECT) method. Using Cantlie's line as a guide, ASGPR dynamics were analyzed separately in the right and left lobes, as well as in the whole liver, using novel indices (the liver uptake ratio [LUR] and the liver uptake density [LUD], which reflect the amount and density of ASGPRs in the liver, respectively). Mean LUR and LUD values for the whole liver and the right and left lobes decreased with increasing progression of chronic viral hepatitis. The LUR for the whole liver correlated well with parameters measuring the hepatic functional reserve and the platelet count. The right LUR correlated particularly well with conventional liver function tests, and comparison of the right LUD with histologic findings showed that it was a good indicator of periportal and/or bridging necrosis and fibrosis. In conclusion, our (99m)Tc-GSA SPECT method was clinically useful in evaluating regional hepatic function and the progression of chronic viral hepatitis using dynamic changes in ASGPRs.

Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

“…To (55). Liver functional volume (by outline extraction method), liver uptake ratio, and liver uptake density were calculated in patients with different severities of parenchymal liver disease.…”

“…Several studies evaluated increased FRL function after PVE using 99m Tc-GSA scintigraphy (46,(53)(54)(55)(56)(57). In 2 studies, the increase in FRL function after PVE was measured by dynamic 99m Tc-GSA SPECT and was compared with an increase in FRL volume, measured by CT volumetry, in cirrhotic and noncirrhotic patients (53,57).…”

Cutoff Values for Dose-liver Function Parameters to Prevent Radiation-induced Liver Disease in Advanced Hepatoma

“…Although we used LHL15 and the total count ratio to represent the liver reserve capacity, radioactivity counts exist outside the SPECT scanning levels. Sugahara et al reported that the index of liver counts/syringe counts for Tc-99m GSA immediately before intravenous injection was 55.9±10.2% in Child A patients and 38.1±12.4% in Child B patients, demonstrating the clear differentiation of liver reserve capacities [14] . Therefore, LHL15 and the total count ratio might be incorporated into this index.…”

“…The SPECT data (90 steps, 360°) were obtained at 20 min with an image matrix of 128×128 and zoom of 1.28. Image reconstruction was conducted with the ordered subset expectation maximization (OSEM) method and Chang's attenuation correction [14] .…”

Treatment strategy for successful hepatic resection of icteric liver

“…Recently, novel tests of FLR, such as serum HA level (13 -15), GSA scintigraphy (16), and interleukin levels (17), have been used to evaluate post-surgical complications. Furthermore, the correlation of LHL15 and HH15 to ICGR15 using a linear regression model and the analysis of individual liver segments by dynamic SPECT are easy and convenient methods for predicting hepatic functional reserve by GSA scintigraphy (18)(19)(20)(21). Therefore, our perioperative protocol for HC patients includes : the drugs (e.g.…”