title: Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer: an appraisal using (99m)Tc-GSA SPECT/CT fusion imaging.
abstract: OBJECTIVE
  To determine the functional discrepancy between the two liver lobes using technetium 99m ((99m)Tc) diethylenetriamine-pentaacetic acid-galactosyl human serum albumin ( GSA diethylenetriamine-pentaacetic acid-galactosyl human serum albumin ) single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging following preoperative biliary drainage and portal vein embolization ( PVE portal vein embolization ) in patients with jaundice who have bile duct cancer ( BDC bile duct cancer ).
  
  
  METHODS
  This retrospective study was approved by the institutional review board, with waiver of informed consent. Preoperative (99m)Tc- GSA diethylenetriamine-pentaacetic acid-galactosyl human serum albumin SPECT/CT fusion images from 32 patients with extrahepatic BDC bile duct cancer were retrospectively reviewed. Patients were classified into four groups according to the extent of biliary drainage and presence of a preoperative right PVE portal vein embolization : right lobe drainage group (right drainage), bilateral lobe drainage group (bilateral drainage), left lobe drainage group (left drainage), and left lobe drainage with right PVE portal vein embolization group (left drainage with right PVE portal vein embolization ). Percentage volume and percentage function were measured in each lobe using fusion imaging. The ratio between percentage function and percentage volume (the function-to-volume ratio) was calculated for each lobe, and the results were compared among the four groups. Statistical analysis was performed with Wilcoxon signed-rank tests and Mann-Whitney U tests.
  
  
  RESULTS
  The median values for the function-to-volume ratio in the right drainage, bilateral drainage, left drainage, and left drainage with right PVE portal vein embolization group were 1.12, 1.05, 1.02, and 0.81 in the right lobe; and 0.51, 0.88, 0.96, and 1.17 in the left lobe. Significant differences in the function-to-volume ratio were observed among the four groups (right drainage vs bilateral drainage vs left drainage vs left drainage with right PVE portal vein embolization ; with P < .002, P = .023, and P < .002 for the right lobe and P < .001, P = .023, and P < .002 for the left lobe).
  
  
  CONCLUSIONS
  Hepatic lobar function significantly differs between the two lobes, depending on the extent of biliary drainage and the presence of portal vein embolization.
authors.affiliation: From the Departments of Gastroenterological Surgery (T.S., Y.S., T.O., A.K., T.T., T.N.), Radiology (Y.N., Y.H., Y.M.), and Gastroenterology (U.K.), Kochi Health Sciences Center, 2125 Ike, Kochi 781-8555, Japan.
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Noda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hata
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Murata
authors.forename: Akihito
authors.initials: A
authors.lastname: Kozuki
authors.forename: Teppei
authors.initials: T
authors.lastname: Tokumaru
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakamura
authors.forename: Kiminori
authors.initials: K
authors.lastname: Uka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate