title: Usefulness of Tc-99m-GSA scintigraphy for liver surgery.
abstract: Postoperative mortality remains high after hepatectomy compared with other types of surgery in patients who have cirrhosis or chronic hepatitis. Although there are several useful perioperative indicators of liver dysfunction, no standard markers are available to predict postoperative liver failure in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. The best preoperative method for evaluating the hepatic functional reserve of patients with HCC remains unclear, but technetium-99m diethylenetriamine pentaacetic acid galactosyl human serum albumin ((99m)Tc-GSA) scintigraphy is a candidate. (99m)Tc-GSA is a liver scintigraphy agent that binds to the asialoglycoprotein receptor, and can be used to assess the functional hepatocyte mass and thus determine the hepatic functional reserve in various physiological and pathological states. The maximum removal rate of (99m) Tc-GSA (GSA-Rmax) calculated by using a radiopharmacokinetic model is correlated with the severity of liver disease. There is also a significant difference of GSA-Rmax between patients with chronic hepatitis and persons with normal liver function. Regeneration of the remnant liver and recurrence of hepatitis C virus infection in the donor organ after living donor liver transplantation have also been investigated by (99m)Tc-GSA scintigraphy. This review discusses the usefulness of (99m)Tc-GSA scintigraphy for liver surgery.
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan. kaibori@hirakata.kmu.ac.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Ha-Kawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Maehara
authors.forename: Morihiko
authors.initials: M
authors.lastname: Ishizaki
authors.forename: Kosuke
authors.initials: K
authors.lastname: Matsui
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sawada
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D017093:Liver Failure / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D011877:Radionuclide Imaging / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin / Q000378:metabolism; D016284:Technetium Tc 99m Pentetate / Q000378:metabolism
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate