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Preoperative Assessment of Residual Hepatic Functional Reserve Using ^99mTc-DTPA-Galactosyl-Human Serum Albumin Dynamic SPECT

Department of Nuclear Medicine, Kanazawa University School of Medicine, Kanazawa
Department of Radiology, Asahikawa Medical College, Asahikawa, Japan

Correspondence: For correspondence or reprints contact: Eui-Hyo Hwang, MD, Department of Nuclear Medicine, Kanazawa University School of Medicine, 13-1 Takaramachi, Kanazawa City, Ishikawa 920-8640, Japan.

ABSTRACT

Preoperative assessment of residual hepatic functional reserve offers important strategic information for hepatic resection. To predict the postoperative residual liver function, we assessed the value of hepatic ^99mTc-diethylenetriamine pentaacetic acid galactosyl-human serum albumin (^99mTc-GSA) clearance estimated by dynamic SPECT analysis. Methods: We investigated 114 consecutive patients with liver disease, including 55 hepatectomy cases. One minute after injection of 185 MBq ^99mTc-GSA, 15 serial dynamic SPECT images were obtained every minute. The initial five sets of SPECT images were analyzed by Patlak plot to estimate the sequential initial hepatic ^99mTc-GSA clearance (mL/min) as an index of hepatic function. The sum of hepatic ^99m-Tc-GSA clearance of the segments immune from resection was categorized as predicted residual ^99mTc-GSA clearance. In the hepatectomy cases, scintigraphy was performed before and 37 ± 10 d after the operation. Results: Good correlation was observed between the total hepatic ^99mTc-GSA clearance and conventional hepatic function tests: plasma retention rate of iodocyanine green (ICG) at 15 min (ICG R15), r = –0.600, P < 0.0001, n = 94; plasma disappearance rate of ICG (K ICG), r = 0.670, P < 0.0001, n = 83; cholinesterase, r = 0.539, P < 0.0001, n = 121; serum albumin, r = 0.421, P = 0.0001, n = 123; and hepaplastin test, r = 0.456, P < 0.0001, n = 120. There was good correlation between the predicted residual ^99mTc-GSA clearance and the postoperative total hepatic ^99mTc-GSA clearance in patients who underwent segmentectomy or lobectomy (r = 0.84, P < 0.0001, n = 28) and between the pre- and postoperative total hepatic ^99m-GSA clearance in patients who under went subsegmentectomy (r = 0.91, P < 0. 0001, n = 25). Five patients who had postoperative complications due to hepatic insufficiency (2 patients died of postoperative hepatic failure within 2 mo after operation) showed significantly lower predicted residual ^99m-GSA clearance compared with the patients without complications (90.3 ± 37.2 versus 320.9 ± 158.8 mL/min; P < 0.005). Conclusion: The total hepatic ^99m-GSA clearance reflected hepatic function. In addition, preoperative predicted residual hepatic ^99m-GSA clearance was a good indicator of postoperative hepatic function and early prognosis. ^99mTc-GSA dynamic SPECT is assumed to be a useful method for determining the surgical strategy in patients with hepatic tumor and especially in patients with hepatic dysfunction.

Key Words: ^99mTc-DTPA-galactosyl-human serum albumin • dynamic SPECT • hepatic resection • functional reserve

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