Preoperative evaluation of hepatic functional reserve by converted ICGR15 calculated from Tc-GSA scintigraphy.
OBJECTIVE
Conversion of data from technetium 99 m diethylenetriaminepentaacetic acid galactosyl human serum albumin (99mTc-GSA) scintigraphy to ICGR15 (indocyanin green retention at 15 min) is an easy and convenient method for obtaining parameters to determine the appropriate and safe extent of liver resection. We investigated a conversion method which also accounts for LHL15 (receptor index: uptake ratio of the liver to the liver plus heart at 15 min) and HH15 (blood clearance index: uptake ratio of the heart at 15 min to that at 3 min) characteristics.


METHODS
Cases included 282 patients undergoing hepatic resection following 99mTc-GSA scintigraphy and an ICG tolerance test. Degree of liver dysfunction was classified as A, B, or C according to criteria of the Liver Cancer Study Group of Japan.


RESULTS
HH15 demonstrated a larger distribution in patients with liver damage A, while LHL15 demonstrated a larger distribution in patients with liver damage B. In liver damage A, the conversion formula ICGR15 = 87.0-79.6 x LHL15 was obtained, and in liver damage B, the conversion formula ICGR15 = -23.3 + 72.4 x HH15 was obtained, and correlation with ICGR15 was higher (r = 0.61, P < 0.0001) than when the data were not segregated by liver damage severity. Furthermore, postoperative hyperbilirubinemia significantly occurred in cases where both ICGR15 and converted ICGR15 were high.


CONCLUSIONS
Conversion models based on data segregated by severity of liver damage were more closely correlated with ICGR15 than conversion models not based on segregated data. By using this converted ICGR15, preoperative estimation of hepatic functional reserve can become more reliable.
Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. h.kawamura@ja-hokkaidoukouseiren.or.jp
Hideki
H
Kawamura
Toshiya
T
Kamiyama
Takahito
T
Nakagawa
Kazuaki
K
Nakanishi
Hideki
H
Yokoo
Munenori
M
Tahara
Hirofumi
H
Kamachi
Hirofumi
H
Toi
Michiaki
M
Matsushita
Satoru
S
Todo
D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D008099:Liver / Q000000981:diagnostic imaging*; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D007208:Indocyanine Green; D016284:Technetium Tc 99m Pentetate