title: Portal uptake function in veno-occlusive regions evaluated by real-time fluorescent imaging using indocyanine green.
abstract: OBJECTIVE
  Although recent advances in preoperative imaging have enabled accurate estimation of the regional liver volume with venous occlusion, the extent of functional decrease in such regions remains unclear. In this study, the portal uptake function in postoperative veno-occlusive regions and non-veno-occlusive regions was evaluated by intraoperative fluorescent imaging after intravenous injection of indocyanine green (ICG).
  
  
  METHODS
  In 22 liver resection patients and 23 recipients and 18 donors of liver transplantation, fluorescent intensity on the remnant liver or the liver graft was evaluated in real time following intravenous injection of ICG (0.0025 mg per 1 ml of remnant liver volume).
  
  
  RESULTS
  Plateau ICG concentrations were significantly lower in the veno-occlusive regions (C(VO)) than in the non-veno-occlusive regions (C(Non)) in liver resection patients (median [range], 0.75 [0.29-2.0]μg/ml vs. 3.0 [0.46-6.4]μg/ml, p<0.001), donors (0.69 [0.29-1.9]μg/ml vs. 2.4 [0.46-6.4]μg/ml, p<0.001), and recipients (0.75 [0.34-1.8]μg/ml vs. 1.8 [0.54-6.4]μg/ml, p<0.001). Distributions of the C(VO)/C(Non) and the ratio of the hepatic uptake rate constant in the veno-occlusive regions to that in non-veno-occlusive regions were both around 40% (mean ± standard deviation, 0.36 ± 0.17 and 0.42 ± 0.16, respectively). When the functional remnant liver volume was calculated as a sum of non-veno-occlusive regions and veno-occlusive regions multiplied by C(VO)/C(Non), its ratio to the total liver volume was correlated with the improved postoperative/preoperative ratio of prothrombin time.
  
  
  CONCLUSIONS
  Portal uptake function in veno-occlusive regions is approximately 40% of that in non-veno-occlusive regions. Intraoperative ICG-fluorescent imaging enables real-time evaluation of the extent of the functional decrease in veno-occlusive regions, enhancing accurate estimation of the hepatic functional reserve for determining the surgical indications and procedures.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Miyata
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamashita
authors.forename: Koichi
authors.initials: K
authors.lastname: Masuda
authors.forename: Shouichi
authors.initials: S
authors.lastname: Satou
authors.forename: Sumihito
authors.initials: S
authors.lastname: Tamura
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006083:Graft Occlusion, Vascular / Q000503:physiopathology*; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007275:Injections, Intravenous; D007432:Intraoperative Period; D008099:Liver / Q000098:blood supply / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D011169:Portal Vein / Q000502:physiology*; D011184:Postoperative Period; D057234:Preoperative Period; D012039:Regional Blood Flow / Q000502:physiology
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green