title: Comparison of Tc-99m-GSA scintigraphy with hepatic fibrosis and regeneration in patients with hepatectomy.
abstract: OBJECTIVE
  Liver regeneration after hepatectomy is correlated with liver fibrosis. Retrospectively, we compared three quantitative indices (HH15, LHL15 and LU15) of Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (Tc-99m-GSA) liver scintigraphy with liver fibrosis; in particular, we compared the HH15 index and the rate of remnant liver regeneration.
  
  
  METHODS
  Fifty-three patients who had undergone hepatectomy were enrolled in this study. The non-neoplastic parts of their resected specimens were divided into 5 groups (F0-F4) according to the degree of liver fibrosis, as determined using the New Inuyama classification system: F0, no fibrosis (n = 12); F1, portal fibrosis widening (n = 12); F2, portal fibrosis widening with bridging fibrosis (n = 14); F3, bridging fibrosis plus lobular distortion (n = 7); F4, liver cirrhosis (n = 8).
  
  
  RESULTS
  When the cases were divided into a no or mild fibrosis group (F0 and F1) and a moderate or severe fibrosis or cirrhosis group (F2, F3 and F4), all of the indices were significantly different between the two groups. In this analysis, the areas (Az) under the receiver operating characteristic (ROC) curves for the HH15 and LHL15 indices were very similar, while the Az for the LU15 index was smaller. An HH15 index equal to 0.52 was the most accurate, producing a 79.3% sensitivity and a 75.0% specificity rating. When 18 patients that had received a CT scan one month after hepatectomy were divided into 2 groups according to their HH15 value (group A, HH15 < or = 0.52; group B, HH15 > 0.52), group A exhibited a better regeneration rate.
  
  
  CONCLUSIONS
  Tc-99m-GSA scintigraphy is well correlated with liver fibrosis and may be useful for non-invasive, preoperative evaluations of liver fibrosis. The HH15 index, in particular, may be useful for predicting the rate of liver regeneration after hepatectomy.
authors.affiliation: Department of Radiology, Okayama University Medical School, Japan. iguchi@cc.okayama-u.ac.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Shuhei
authors.initials: S
authors.lastname: Sato
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kouno
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Okumura
authors.forename: Shiro
authors.initials: S
authors.lastname: Akaki
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tsuda
authors.forename: Keita
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanazawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hiraki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D005189:False Positive Reactions; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008103:Liver Cirrhosis / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D008111:Liver Function Tests / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate