title: Assessment of hepatic functional regeneration after hepatectomy using (99m)Tc-GSA SPECT/CT fused imaging.
abstract: BACKGROUND
  The liver itself regenerates after hepatectomy but little is known about how much hepatic function recovers during the regeneration. The liver uptake value (LUV), calculated from Tc-99m-labeled galactosyl-human-serum-albumin ((99m)Tc-GSA) SPECT/CT fused images, is reliable and useful for evaluating hepatic function. In this study, we evaluated the clinical usefulness of LUV for estimating hepatic functional regeneration after hepatectomy.
  
  
  METHODS
  We enrolled 95 patients who had undergone (99m)Tc-GSA SPECT/CT tests before/on days 30 and 90 after hepatectomy. We determined the LUV from the (99m)Tc-GSA SPECT/CT images and calculated the %LUV (postoperative LUV/preoperative LUV × 100). Based on surgical procedures and histopathological damage, we divided the study population into patients with severe (n = 12) or non-severe fibrosis (n = 33) who had undergone minor hepatectomy, and patients with severe (n = 14) or non-severe fibrosis (n = 36) having major hepatectomy. On the 90th post-hepatectomy day, five patients manifested liver failure; in these patients, we analyzed the co-relation between liver failure and the results of the liver function tests performed on day 30 after surgery.
  
  
  RESULTS
  Although the %LUV reached 95.4 ± 12.2 % in 30 days, in patients with severe fibrosis after major hepatectomy it remained below 90 %. Patients having low %LUV (<75 %) and high serum bilirubin (>2.0 mg/dl) at 30 days showed a relative risk of liver failure of 12.0 and 4.5 (p < 0.001 and p < 0.001), respectively.
  
  
  CONCLUSIONS
  Although the %LUV recovered to about 95 % in all patients within 30 days after the hepatectomy, in patients with severe fibrosis having major hepatectomy, the process of recovery was delayed. The %LUV corresponded to the quality of the liver function which emerged in a later post-hepatectomy phase.
authors.affiliation: Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Chuo-ku, Honjo, Kumamoto, Japan, mo-yoshi@kumamoto-u.ac.jp.
authors.forename: Morikatsu
authors.initials: M
authors.lastname: Yoshida
authors.forename: Shinya
authors.initials: S
authors.lastname: Shiraishi
authors.forename: Fumi
authors.initials: F
authors.lastname: Sakamoto
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Utsunomiya
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okabe
authors.forename: Seiji
authors.initials: S
authors.lastname: Tomiguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000502:physiology*; D017093:Liver Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D012038:Regeneration; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin / Q000737:chemistry*; D016284:Technetium Tc 99m Pentetate / Q000737:chemistry*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D001663:Bilirubin; D016284:Technetium Tc 99m Pentetate