title: Fractal Dimension of Tc-99m DTPA GSA Estimates Pathologic Liver Injury due to Chemotherapy in Liver Cancer Patients.
abstract: Chemotherapy-induced liver injury after potent chemotherapy is a considerable problem in patients undergoing liver resection. The aim of this study was to assess the relationship between the fractal dimension (FD) of Tc-99m diethylenetriaminepentaacetic acid (DTPA) galactosyl human serum albumin (GSA) and pathologic change of liver parenchyma in liver cancer patients who have undergone chemotherapy.
  
  
  
  We examined 34 patients (10 female and 24 male; mean age, 68.5 years) who underwent hepatectomy. Hepatic injury was defined as steatosis more than 30 %, grade 2-3 sinusoidal dilation, and/or steatohepatitis Kleiner score ≥4. Fractal analysis was applied to all images of Tc-99m DTPA GSA using a plug-in tool on ImageJ software (NIH, Bethesda, MD). A differential box-counting method was applied, and FD was calculated as a heterogeneity parameter. Correlations between FD and clinicopathological variables were examined.
  
  
  
  FD values of patients with steatosis and steatohepatitis were significantly higher than those without (P > .001 and P > .001, respectively). There was no difference between the FD values of patients with and without sinusoidal dilatation (P = .357). Multivariate logistic regression showed FD as the only significant predictor for steatosis (P = .005; OR 36.5; 95 % CI 3.0-446.3) and steatohepatitis (P = .012; OR, 29.1; 95 % CI 2.1-400.1).
  
  
  
  FD of Tc-99m DTPA GSA was the significant predictor for fatty liver disease in patients who underwent chemotherapy. This new modality is able to differentiate steatohepatitis from steatosis; therefore, it may be useful for predicting chemotherapy-induced pathologic liver injury.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.affiliation: Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawaguchi
authors.affiliation: Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Kasahara
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirano
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Mikito
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kosugi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan. u17-92ts@med.teikyo-u.ac.jp.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging* / Q000473:pathology; D005234:Fatty Liver / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D017709:Fractals; D006498:Hepatectomy; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011237:Predictive Value of Tests; D012372:ROC Curve; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012307:Risk Factors; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate
chemical_list: D009944:Organoplatinum Compounds; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D016284:Technetium Tc 99m Pentetate; D002166:Camptothecin