title: Hepatobiliary scintigraphy may improve radioembolization treatment planning in HCC patients.
abstract: BACKGROUND
  Routine work-up for transarterial radioembolization, based on clinical and laboratory parameters, sometimes fails, resulting in severe hepatotoxicity in up to 5% of patients. Quantitative assessment of the pretreatment liver function and its segmental distribution, using hepatobiliary scintigraphy may improve patient selection and treatment planning. A case series will be presented to illustrate the potential of this technique. Hepatocellular carcinoma patients with cirrhosis (Child-Pugh A and B) underwent hepatobiliary scintigraphy pre- and 3 months post-radioembolization as part of a prospective study protocol, which was prematurely terminated because of limited accrual. Included patients were analysed together with their clinical, laboratory and treatment data.
  
  
  RESULTS
  Pretreatment-corrected99mTc-mebrofenin liver uptake rates were marginal (1.8-3.0%/min/m2), despite acceptable clinical and laboratory parameters. Posttreatment liver functions seriously declined (corrected99mTc-mebrofenin liver uptake rates: 0.6-2.4%/min/m2), resulting in lethal radioembolization-induced liver disease in two out of three patients.
  
  
  CONCLUSIONS
  Hepatobiliary scintigraphy may be of added value during work-up for radioembolization, to estimate liver function reserve and its segmental distribution, especially in patients with underlying cirrhosis, for whom analysis of clinical and laboratory parameters may not be sufficient.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. M.N.G.Braat-3@umcutrecht.nl.
authors.forename: Manon N G J A
authors.initials: MNGJA
authors.lastname: Braat
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Hugo W
authors.initials: HW
authors.lastname: de Jong
authors.affiliation: Department of Radiology and Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Beatrijs A
authors.initials: BA
authors.lastname: Seinstra
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Mike V
authors.initials: MV
authors.lastname: Scholten
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Maurice A A J
authors.initials: MAAJ
authors.lastname: van den Bosch
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: Marnix G E H
authors.initials: MGEH
authors.lastname: Lam
keywords: Hepatobiliary scintigraphy; Hepatotoxicity; Radioembolization; Yttrium-90