title: Liver function assessment using 99mTc-GSA single-photon emission computed tomography (SPECT)/CT fusion imaging in hilar bile duct cancer: A retrospective study.
abstract: The objective of this study was to determine the utility of Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging for posthepatectomy remnant liver function assessment in hilar bile duct cancer patients.
  
  
  
  Thirty hilar bile duct cancer patients who underwent major hepatectomy with extrahepatic bile duct resection were retrospectively analyzed. Indocyanine green plasma clearance rate (KICG) value and estimated KICG by (99m)Tc-GSA scintigraphy (KGSA) and volumetric and functional rates of future remnant liver by (99m)Tc-GSA SPECT/CT fusion imaging were used to evaluate preoperative whole liver function and posthepatectomy remnant liver function, respectively. Remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) were used to predict future remnant liver function; major hepatectomy was considered unsafe for values <0.05. The correlation of remKICG and remKGSA with posthepatectomy mortality and morbidity was determined.
  
  
  
  Although remKICG and remKGSA were not significantly different (median value: 0.071 vs 0.075), functional rates of future remnant liver were significantly higher than volumetric rates (median: 0.54 vs 0.46; P < .001). Hepatectomy was considered unsafe in 17% and 0% of patients using remKICG and remKGSA, respectively. Postoperative liver failure and mortality did not occur in the patients for whom hepatectomy was considered unsafe based on remKICG. remKGSA showed a stronger correlation with postoperative prothrombin time activity than remKICG.
  
  
  
  (99m)Tc-GSA SPECT/CT fusion imaging enables accurate assessment of future remnant liver function and suitability for hepatectomy in hilar bile duct cancer patients.
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan. Electronic address: tasu050520@yahoo.co.jp.
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Kozuki
authors.affiliation: Department of Radiology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hata
authors.affiliation: Department of Radiology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Noda
authors.affiliation: Department of Radiology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Michihiko
authors.initials: M
authors.lastname: Kouno
authors.affiliation: Department of Radiology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Miyagawa
authors.affiliation: Department of Radiology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Tokorodani
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Saisaka
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Tokumaru
authors.affiliation: Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Radiology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Sojiro
authors.initials: S
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006500:Hepatic Duct, Common; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate