title: Preoperative assessment of residual hepatic functional reserve using 99mTc-DTPA-galactosyl-human serum albumin dynamic SPECT.
abstract: Preoperative assessment of residual hepatic functional reserve offers important strategic information for hepatic resection. To predict the postoperative residual liver function, we assessed the value of hepatic 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) clearance estimated by dynamic SPECT analysis.
  
  
  METHODS
  We investigated 114 consecutive patients with liver disease, including 55 hepatectomy cases. One minute after injection of 185 MBq 99mTc-GSA, 15 serial dynamic SPECT images were obtained every minute. The initial five sets of SPECT images were analyzed by Patlak plot to estimate the sequential initial hepatic 99mTc-GSA clearance (mL/min) as an index of hepatic function. The sum of hepatic 99mTc-GSA clearance of the segments immune from resection was categorized as predicted residual 99mTC-GSA clearance. In the hepatectomy cases, scintigraphy was performed before and 37 +/- 10 d after the operation.
  
  
  RESULTS
  Good correlation was observed between the total hepatic 99mTc-GSA clearance and conventional hepatic function tests: plasma retention rate of iodocyanine green (ICG) at 15 min (ICG R15), r = -0.600, P < 0.0001, n = 94; plasma disappearance rate of ICG (K ICG), r = 0.670, P < 0.0001, n = 83; cholinesterase, r = 0.539, P < 0.0001, n = 121; serum albumin, r = 0.421, P = 0.0001, n = 123; and hepaplastin test, r = 0.456, P < 0.0001, n = 120. There was good correlation between the predicted residual 99mTc-GSA clearance and the postoperative total hepatic 99mTc-GSA clearance in patients who underwent segmentectomy or lobectomy (r = 0.84, P < 0.0001, n = 28) and between the pre- and postoperative total hepatic 99mTc-GSA clearance in patients who underwent subsegmentectomy (r = 0.91, P < 0.0001, n = 25). Five patients who had postoperative complications due to hepatic insufficiency (2 patients died of postoperative hepatic failure within 2 mo after operation) showed significantly lower predicted residual 99mTc-GSA clearance compared with the patients without complications (90.3 +/- 37.2 versus 320.9 +/- 158.8 mL/min; P < 0.005).
  
  
  CONCLUSIONS
  The total hepatic 99mTC-GSA clearance reflected hepatic function. In addition, preoperative predicted residual hepatic 99mTc-GSA clearance was a good indicator of postoperative hepatic function and early prognosis. 99mTc-GSA dynamic SPECT is assumed to be a useful method for determining the surgical strategy in patients with hepatic tumor and especially in patients with hepatic dysfunction.
authors.affiliation: Department of Nuclear Medicine, Kanazawa University School of Medicine, Kanazawa City, Ishikawa, Japan.
authors.forename: E H
authors.initials: EH
authors.lastname: Hwang
authors.forename: J
authors.initials: J
authors.lastname: Taki
authors.forename: N
authors.initials: N
authors.lastname: Shuke
authors.forename: K
authors.initials: K
authors.lastname: Nakajima
authors.forename: S
authors.initials: S
authors.lastname: Kinuya
authors.forename: S
authors.initials: S
authors.lastname: Konishi
authors.forename: T
authors.initials: T
authors.lastname: Michigishi
authors.forename: T
authors.initials: T
authors.lastname: Aburano
authors.forename: N
authors.initials: N
authors.lastname: Tonami
mesh_terms: D004396:Coloring Agents / Q000378:metabolism; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D017093:Liver Failure / Q000000981:diagnostic imaging; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D009930:Organic Chemicals; D011379:Prognosis; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics; D016284:Technetium Tc 99m Pentetate / Q000493:pharmacokinetics; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D009930:Organic Chemicals; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; C035709:iodocyanine green; D016284:Technetium Tc 99m Pentetate