Using Dynamic 99mTc-GSA SPECT/CT Fusion Images for Hepatectomy Planning and Postoperative Liver Failure Prediction

Mao, Yilei; Du, Shunda; Ba, Jiantao; Li, Fang; Yang, Huayu; Lu, Xin; Sang, Xinting; Li, Shaohua; Che, Lu; Tong, Junxiang; Xu, Yiyao; Xu, Haifeng; Zhao, Haitao; Chi, Tianyi; Liu, Fang; Du, Ying; Zhang, Xianzhong; Wang, Xuebin; Dong, Jiahong; Zhong, Shouxian; Huang, Jiefu; Yu, Yong‐Ming; Wang, Jiping

doi:10.1245/s10434-014-4117-4

Cited by 26 publications

(19 citation statements)

References 21 publications

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“…There are several 99mTc-GSA SPECT parameters such as the liver uptake ratio (LUR) [74,75], liver uptake density [74,76], liver uptake value corrected for body surface area (LUV) [77], or uptake index [78,79]; all these parameters basically depend on the regional strength of radioactivity in the liver. The parameter LUR correlates well with the extent of ASGPR expression immunohistochemically evaluated, and a parallel decrease in LUR and ASGPR protein expression was observed in the fibrotic liver [80].…”

Section: Gsa-spect Fusion Imagementioning

confidence: 99%

ICG Clearance Test and 99mTc-GSA SPECT/CT Fusion Images

Iimuro¹

2017

Visc Med

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Preoperative estimation of future remnant liver function is critical for major hepatic surgery to avoid postoperative morbidity and mortality. Among several liver function tests, the indocyanine green (ICG) clearance test is still the most popular dynamic method. The usefulness of ICG clearance test parameters, such as ICGR15, K_ICG, or PDR_ICG, has been reported by many investigators. The transcutaneous non-invasive pulse dye densitometry system has made the ICG clearance test more convenient and attractive, even in Western countries. The concept of future remnant K_ICG (rem K_ICG), which combines the functional aspect and the volumetric factor of the future remnant liver, seems ideal for determining the maximum extent of major hepatic resection that will not cause postoperative liver failure. For damaged livers with functional heterogeneity among the hepatic segments, fusion images combining technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin single photon emission computed tomography (99mTc-GSA SPECT) and X-ray CT are helpful to precisely estimate the functional reserve of the future remnant liver. Another technique for image-based liver function estimation, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB)-enhanced magnetic resonance imaging, may be an ideal candidate for the preoperative determination of future remnant liver function. Using these methods effectively, morbidity and mortality after major hepatic resection could be reduced.

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Section: Gsa-spect Fusion Imagementioning

confidence: 99%

ICG Clearance Test and 99mTc-GSA SPECT/CT Fusion Images

Iimuro¹

2017

Visc Med

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“…99m Tc-GSA scintigraphy is often used to evaluate hepatic functional reserve [18, 33-37]. Kubota et al [38] reported a significant difference in LHL15 between patients with chronic hepatitis and those with liver cirrhosis and that LHL15 was significantly correlated with laboratory values of liver function.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a system that combines the assessment of liver function with 99m Tc-GSA and the uptake index with three-dimensional CT imaging has been used to provide three-dimensional functional imaging of the liver [18, 50]. Mao et al [18] demonstrated that this new methodology reliably estimated the function of the future remnant liver and predicted the risk of liver failure.…”

Section: Discussionmentioning

confidence: 99%

“…Mao et al [18] demonstrated that this new methodology reliably estimated the function of the future remnant liver and predicted the risk of liver failure. However, currently, only few institutions are equipped with this new methodology, and remnant LHL15 obtained from LHL15 and CT volumetry data remain easy to use.…”

Section: Discussionmentioning

confidence: 99%

“…99m technetium-labelled galactosyl human serum albumin (99m Tc-GSA), which is an agent that binds to asialoglycoprotein receptors, is widely used in scintigraphy to quantitatively estimate the preoperative liver function [14-18]. Previous studies have reported the clinical usefulness of a 99m Tc-GSA single-photon emission computed tomography (SPECT)/ computed tomography (CT) fusion imaging to evaluate regional hepatic function and predict postoperative hepatic functional reserve [19-21].…”

Section: Introductionmentioning

confidence: 99%

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Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

et al. 2018

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Background: Posthepatectomy liver failure (PHLF) was recently defined with the corresponding recommendations as follows: grade A, no change in clinical management; grade B, clinical management with noninvasive treatment; and grade C, clinical management with invasive treatment. In this study, we identified the risk factors for grade B and C PHLF in patients with hepatocellular carcinoma (HCC). Methods: Of 339 HCC patients who underwent curative hepatic resection, 218 were included for analysis. The LHL15 index (uptake ratio of the liver to that of the liver and heart at 15 min) was measured by 99m Tc-GSA (99m technetium-labelled galactosyl human serum albumin); remnant LHL15 was calculated as LHL15 × [1 − (resected liver weight − tumor volume)/whole liver volume without tumor]. Results: A total of 163 patients were classified as having no PHLF, whereas 17, 37, and 1 patient had PHLF grade A, B, and C, respectively. There were significant differences in indocyanine green R15, serum albumin, prothrombin time, Child-Pugh classification, LHL15 and remnant LHL15 between patients with grades B/C PHLF and patients with grade A or no PHLF. Only remnant LHL15 was identified as an independent risk factor for grades B/C PHLF (p = 0.023), with a cut-off value of 0.755. Conclusions: Remnant LHL15 was an independent risk factor for grades B/C PHLF. Patients with impaired remnant LHL15 value of <0.755 should be carefully monitored for PHLF.

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Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

Nishio

Taura

Koyama

et al. 2023

Annals of Gastroent Surgery

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Liver resection is an effective therapeutic option for patients with hepatocellular carcinoma. However, posthepatectomy liver failure (PHLF) remains a major cause of hepatectomy‐related mortality, and the accurate prediction of PHLF based on preoperative assessment of liver functional reserve is a critical issue. The definition of PHLF proposed by the International Study Group for Liver Surgery has gained acceptance as a standard grading criterion. Liver function can be estimated using a variety of parameters, including routine blood biochemical examinations, clinical scoring systems, dynamic liver function tests, liver stiffness and fibrosis markers, and imaging studies. The Child–Pugh score and model for end‐stage liver disease scores are conventionally used for estimating liver decompensation, although the alternatively developed albumin‐bilirubin score shows superior performance for predicting hepatic dysfunction. Indocyanine green clearance, a dynamic liver function test mostly used in Japan and other Asian countries, serves as a quantitative estimation of liver function reserve and helps determine indications for surgical procedures according to the estimated risk of PHLF. In an attempt to improve predictive accuracy, specific evaluation of liver fibrosis and portal hypertension has gained popularity, including liver stiffness measurements using ultrasonography or magnetic resonance elastography, as well as noninvasive fibrosis markers. Imaging modalities, including Tc‐99m‐labeled galactosyl serum albumin scintigraphy and gadolinium‐enhanced magnetic resonance imaging, are used for preoperative evaluation in combination with liver volume. This review aims to provide an overview of the usefulness of current options for the preoperative assessment of liver function in predicting PHLF.

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Using Dynamic 99mTc-GSA SPECT/CT Fusion Images for Hepatectomy Planning and Postoperative Liver Failure Prediction

Abstract: The new methodology reliably estimates FRL function and predicts the risk of liver failure. It provides a visual aid for liver surgeon in surgery planning and risk assessment.

Cited by 26 publications

References 21 publications

ICG Clearance Test and 99mTc-GSA SPECT/CT Fusion Images

ICG Clearance Test and 99mTc-GSA SPECT/CT Fusion Images

Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

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