title: Preoperative assessment of postoperative remnant liver function using hepatobiliary scintigraphy.
abstract: Hepatic resection is the therapy of choice for malignant and symptomatic benign hepatobiliary tumors. The concept of remnant liver volume (RLV) has been introduced and can be assessed with CT. However, inhomogeneous liver function distribution and a lack of correlation between morphologic hypertrophy and functional recovery fuelled the enthusiasm for functional imaging. The aim of the present study was to assess liver function reserve (LFR) and remnant liver function (RLF) before and after major liver surgery with hepatobiliary scintigraphy (HBS) and to compare scintigraphic results with volumetric CT data and indocyanine-green (ICG) clearance test results. Furthermore, HBS was used to assess functional recovery of liver function, and results were compared with volumetric data.
  
  
  METHODS
  Fifteen patients with a partial liver resection were included. HBS was performed before, 1 d after, and 3 mo after surgery. ICG clearance and CT were performed before and 3 mo after surgery. Liver function determined with HBS was compared with ICG and volumetric data.
  
  
  RESULTS
  Liver function determination using HBS was highly reproducible. A strong positive association (r = 0.84) was found between LFR determined with HBS and ICG clearance. Little or no association (r = 0.27) was found between CT volumetric analysis and corresponding ICG clearance. A strong positive association (r = 0.95) was found between the RLF determined preoperatively on HBS and the actually measured value postoperatively. A weak positive association (r = 0.61) was found between functional liver regeneration and liver volume regeneration in the 3 mo after partial liver resection.
  
  
  CONCLUSIONS
  HBS offers a unique combination of functional liver uptake and excretion with the ability to assess the preoperative LFR and to estimate the RLF preoperatively. Determination of the RLF instead of the RLV might clarify some of the discrepancies observed in the literature between RLV and clinical outcome in patients with an inhomogeneous liver function. Finally, liver function regeneration can be monitored using HBS.
authors.affiliation: Department of Nuclear Medicine, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands. r.bennink@amc.uva.nl
authors.forename: Roelof J
authors.initials: RJ
authors.lastname: Bennink
authors.forename: Sander
authors.initials: S
authors.lastname: Dinant
authors.forename: Deha
authors.initials: D
authors.lastname: Erdogan
authors.forename: Bob H
authors.initials: BH
authors.lastname: Heijnen
authors.forename: Irene H
authors.initials: IH
authors.lastname: Straatsburg
authors.forename: Arlene K
authors.initials: AK
authors.lastname: van Vliet
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008111:Liver Function Tests / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011865:Radioisotope Dilution Technique; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine