Preoperative assessment of liver function: a comparison of 99mTc-Mebrofenin scintigraphy with indocyanine green clearance test.
OBJECTIVE
The indocyanine green (ICG) clearance test is the most frequently used test for preoperative assessment of liver parenchymal function but has its limitations. The aim of this study was to investigate the correlation between ICG clearance test and the liver uptake of 99-Technetium-labelled (99mTc)-Mebrofenin (99mTc-Mebrofenin) as measured with hepatobiliary scintigraphy.


METHODS
Fifty-four patients were diagnosed as hepatocellular carcinoma (n=9), hilar tumours (n=20) and 25 patients with non-parenchymal tumours including colorectal metastasis (n=15) and miscellaneous tumours (n=10). One day prior to operation, hepatobiliary 99mTc-Mebrofenin scintigraphy was performed after intravenous injection of 85 MBq and the 15-min clearance rate of ICG (ICG-C15) was measured.


RESULTS
The mean ICG-C15 was 86.86+/-1.19% (SEM). The mean 99mTc-Mebrofenin uptake rate was 12.87+/-0.52%/min. A significant correlation was obtained between 99mTc-Mebrofenin uptake rate by scintigraphy and ICG-C15 (r=0.73, P<0.0001). The mean clearance capacity of the right liver segments (79.83+/-1.63, range 47.75-95.97%) was larger than that of the left segments (20.24+/-1.55, range 6.51-52.51%).


CONCLUSIONS
99mTc-Mebrofenin uptake rate as assessed by scintigraphy is an efficient method for determining liver function and correlates well with ICG clearance. At the same time, 99mTc-Mebrofenin scintigraphy provides information of segmental functional liver tissue, which is of additional use when planning liver resection.
Erdogan
Deha
D
Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
Heijnen
Bob H M
BH
Bennink
Roelof J
RJ
Kok
Mariël
M
Dinant
Sander
S
Straatsburg
Irene H
IH
Gouma
Dirk J
DJ
van Gulik
Thomas M
TM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000814:Aniline Compounds; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids / Q000493:pharmacokinetics; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D011300:Preoperative Care; D011877:Radionuclide Imaging; D015203:Reproducibility of Results
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D007208:Indocyanine Green; D005998:Glycine