Preoperative estimation of asialoglycoprotein receptor expression in the remnant liver from CT/99mTc-GSA SPECT fusion images correlates well with postoperative liver function parameters.
BACKGROUND
Accurate preoperative estimation of remnant liver function is critically important for hepatic surgery, and the expression of asialoglycoprotein receptors (ASGPR) is associated with hepatic function.


METHODS
Thirty-two patients with hepatocellular carcinoma who underwent surgical resection were studied. To estimate the expression of ASGPR in the remnant liver, simulated surgery was performed on fusion images that combined data from (99m)technetium-galactosyl human serum albumin ((99m)Tc-GSA)/single photon emission computed tomography (SPECT) and computed tomography (CT) scanning. The liver uptake ratio (LUR) of (99m)Tc-GSA and the functional liver volume (FLV) in the remnant liver were predicted and were compared with postoperative liver function parameters.


RESULTS
The LUR of (99m)Tc-GSA was strongly correlated with the extent of hepatic ASGPR expression (r = 0.944, p = 5.01 x 10(-16)), being confirmed to be a reliable parameter for the evaluation of liver function. The estimated remnant LUR, but not the estimated remnant FLV, was significantly correlated with postoperative liver function parameters, such as serum total bilirubin (r = -0.430, p < 0.05), prothrombin activity (r = 0.515, p < 0.01), and serum cholinesterase activity (r = 0.546, p < 0.01) at 1 week.


CONCLUSIONS
Preoperative estimation of the extent of ASGPR expression in the remnant liver on CT/GSA-SPECT fusion images correlated well with postoperative liver function parameters, suggesting its usefulness for surgical decisions.
Iimuro
Yuji
Y
Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 66-8501, Japan.
Kashiwagi
Toru
T
Yamanaka
Junichi
J
Hirano
Tadamichi
T
Saito
Shinichi
S
Sugimoto
Takaaki
T
Watanabe
Shinichiro
S
Kuroda
Nobukazu
N
Okada
Toshihiro
T
Asano
Yasukane
Y
Uyama
Naoki
N
Fujimoto
Jiro
J
D000368:Aged; D000369:Aged, 80 and over; D037263:Asialoglycoprotein Receptor / Q000096:biosynthesis*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics; D016284:Technetium Tc 99m Pentetate / Q000493:pharmacokinetics; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D037263:Asialoglycoprotein Receptor; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate