^99mTc-Mebrofenin Hepatobiliary Scintigraphy with SPECT for the Assessment of Hepatic Function and Liver Functional Volume Before Partial Hepatectomy

Abstract

Preoperative evaluation of future remnant liver (FRL) function is crucial in the determination of whether a patient can safely undergo liver resection. Although dynamic 99m Tc-mebrofenin hepatobiliary scintigraphy (HBS) is used to measure FRL function, 2-dimensional planar images lack the ability to assess segmental liver function. Modern SPECT/CT cameras combine dynamic 99m Tc-mebrofenin HBS with additional SPECT and the anatomic information of the CT scan. The aim of this study was to evaluate the additional value of 99m Tc-mebrofenin SPECT for the measurement of segmental liver function and liver functional volume. Methods: Preoperative CT volumetry and 99m Tc-mebrofenin HBS with SPECT were performed in 36 patients undergoing liver resection. In 18 patients, postoperative 99m Tc-mebrofenin HBS with SPECT was performed within 3 d after operation. Dual-head dynamic acquisitions were used to calculate FRL function using anterior and geometric mean (Gmean) datasets. Total and FRL functional liver volumes were measured by SPECT. Results: Because of the anatomic position of the liver, the anterior projection resulted in an underestimation of FRL function in patients undergoing left hemihepatectomy. In patients with normal liver parenchyma, total functional liver volume was comparable to total liver volume measured by CT volumetry, indicating that 99m Tc-mebrofenin SPECT is an accurate method to measure hepatic volume. In compromised livers, compared with normal livers, FRL function per cubic centimeter of liver volume was significantly less. In addition, liver function was not distributed homogeneously, with the segments to be resected relatively more affected. FRL function, measured by a combination of SPECT and dynamic HBS, was able to accurately predict actual postoperative remnant liver function. Conclusion: The Gmean dataset is recommended for the assessment of hepatic function by dynamic planar 99m Tc-mebrofenin HBS. The combination of SPECT data with the dynamic uptake function measured by planar HBS provides valuable visible and quantitative information regarding segmental liver function and is an accurate measure for FRL function.

The emerging role of transport systems in liver function tests

“…Noninvasive methods such as scintigraphy or MRI are already under clinical investigation and have demonstrated to predict the remaining functional liver mass in patients scheduled for resection (de Graaf et al, 2010c). Future studies should be designed such that they yield a clear definition and grading of posthepatectomy liver failure, which is currently not classified by a generally accepted scoring system (Rahbari et al, 2011).…”

Measurement of liver function using hepatobiliary scintigraphy improves risk assessment in patients undergoing major liver resection

“…3,4 99m Tc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT is a quantitative method of liver functional assessment, 5 which allows measurement of the FRL-function depending on quality of the liver parenchyma rather than volume alone. 6 HBS can therefore be applied in both patients with compromised and non-compromised liver, using the previously calculated cut-off value of 2.7%/min/m 2 . 7 Patients with FRL uptake function below the cut-off value have a risk of postoperative liver failure of 2.4% with negative predictive value of 97.6% and a likelihood ratio for negative test result of 0.12.…”

Gd-EOB-DTPA-enhanced MRI for the assessment of liver function and volume in liver cirrhosis

“…In a group of patients with diverse underlying liver pathologies investigated with 99m Tc-mebrofenin, it was found that liver function was unevenly distributed within the liver [11]. Regional variations in uptake were also demonstrated using 99m Tc-labelled galactosyl human serum albumin [12,13].…”