Assessment of hepatic functional regeneration after hepatectomy using (99m)Tc-GSA SPECT/CT fused imaging.

Abstract

BACKGROUND:

The liver itself regenerates after hepatectomy but little is known about how much hepatic function recovers during the regeneration. The liver uptake value (LUV), calculated from Tc-99m-labeled galactosyl-human-serum-albumin ((99m)Tc-GSA) SPECT/CT fused images, is reliable and useful for evaluating hepatic function. In this study, we evaluated the clinical usefulness of LUV for estimating hepatic functional regeneration after hepatectomy.

METHODS:

We enrolled 95 patients who had undergone (99m)Tc-GSA SPECT/CT tests before/on days 30 and 90 after hepatectomy. We determined the LUV from the (99m)Tc-GSA SPECT/CT images and calculated the %LUV (postoperative LUV/preoperative LUV × 100). Based on surgical procedures and histopathological damage, we divided the study population into patients with severe (n = 12) or non-severe fibrosis (n = 33) who had undergone minor hepatectomy, and patients with severe (n = 14) or non-severe fibrosis (n = 36) having major hepatectomy. On the 90th post-hepatectomy day, five patients manifested liver failure; in these patients, we analyzed the co-relation between liver failure and the results of the liver function tests performed on day 30 after surgery.

RESULTS:

Although the %LUV reached 95.4 ± 12.2 % in 30 days, in patients with severe fibrosis after major hepatectomy it remained below 90 %. Patients having low %LUV (<75 %) and high serum bilirubin (>2.0 mg/dl) at 30 days showed a relative risk of liver failure of 12.0 and 4.5 (p < 0.001 and p < 0.001), respectively.

CONCLUSIONS:

Although the %LUV recovered to about 95 % in all patients within 30 days after the hepatectomy, in patients with severe fibrosis having major hepatectomy, the process of recovery was delayed. The %LUV corresponded to the quality of the liver function which emerged in a later post-hepatectomy phase.

• Authors: Morikatsu Yoshida, Shinya Shiraishi, Fumi Sakamoto, Toru Beppu, Daisuke Utsunomiya, Hirohisa Okabe, Seiji Tomiguchi, Hideo Baba, Yasuyuki Yamashita
• Journal: Annals of nuclear medicine (Ann Nucl Med) Vol. 28 Issue 8 Pg. 780-8 (Oct 2014) ISSN: 1864-6433 [Electronic] Japan
• PMID: 25001260 (Publication Type: Journal Article)

Chemical References

• Technetium Tc 99m Aggregated Albumin
• technetium Tc 99m DTPA-galactosyl-human serum albumin
• Bilirubin
• Technetium Tc 99m Pentetate

Topics

• Aged
• Bilirubin (blood)
• Female
• Fibrosis (pathology)
• Hepatectomy
• Humans
• Liver (diagnostic imaging, physiology)
• Liver Failure (blood, diagnostic imaging, surgery)
• Liver Neoplasms (diagnostic imaging, surgery)
• Male
• Middle Aged
• Multimodal Imaging
• Neoplasm Metastasis
• Regeneration
• Reproducibility of Results
• Retrospective Studies
• Technetium Tc 99m Aggregated Albumin (chemistry)
• Technetium Tc 99m Pentetate (chemistry)
• Tomography, Emission-Computed, Single-Photon (methods)
• Tomography, X-Ray Computed (methods)