HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bennink, R. J. Articles by van Gulik, T. M. Search for Related Content PubMed PubMed Citation Articles by Bennink, R. J. Articles by van Gulik, T. M.

Preoperative Assessment of Postoperative Remnant Liver Function Using Hepatobiliary Scintigraphy

¹ Department of Nuclear Medicine, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
² Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands

View larger version (77K): [in a new window]   FIGURE 1. Preoperative HBS in patient 13, with a proximal cholangiocarcinoma. (A) Reframed images of the dynamic acquisition. Homogeneous liver uptake with moderate cholestasis is seen in the left side, without functional repercussion. (B) A summed image from 150 to 350 s after intravenous injection of 80 MBq of 99mTc-mebrofenin, with an ROI drawn semiautomatically (threshold, 20%) around the entire liver and a second ROI drawn in the mediastinum (blood pool). (C) A blood-pool–corrected liver-uptake time–activity curve. Liver uptake (d) is calculated as the increase in specific (corrected for blood pool) 99mTc-mebrofenin uptake (y-axis) per minute over a period of 200 s (x-axis).

View larger version (20K): [in a new window]   FIGURE 2. Scatter plots with linear regression line of HBS liver function calculation reproducibility (A), HBS and ICG clearance LFR assessment (B), HBS preoperative and postoperative (postop.) RLF measurement (C), and liver volume and function recovery (D).

View larger version (8K): [in a new window]   FIGURE 3. Bland–Altman plots of hepatic 99mTc-mebrofenin uptake, expressed as percentage uptake per minute. (A) A plot of the mean of the repeated liver uptake function calculation on HBS in 45 studies (horizontal axis) vs. the differences in the repeated calculations (vertical axis). (B) A plot of the mean of FLR determination on HBS before and after surgery in 15 studies (horizontal axis) vs. the differences in the repeated measurements (vertical axis). The horizontal solid lines indicate the mean difference between the 2 calculations. The horizontal dashed lines indicate the 95% limits of agreement (mean ± 1.96 SD).

View larger version (33K): [in a new window]   FIGURE 4. Summed images of patient 3 from 150 to 350 s after intravenous injection of 80 MBq of 99mTc-mebrofenin preoperatively (A), 1 d postoperatively after right-sided hemihepatectomy (B), and 3 mo postoperatively (C). Images are normalized to the preoperative HBS. In A, an ROI is drawn over the entire liver (black), the future remnant liver (white), and the mediastinal blood pool (bl). The ROIs were copied on the HBS performed 1 d and 3 mo postoperatively. The total liver function was 16.05%/min, and the RLF was estimated at 5.88%/min on preoperative HBS. The measured RLF 1 d postoperatively was 5.15%/min. After 3 mo, liver function recovered to 12.80%/min, with hypertrophy visible on HBS.

View larger version (27K): [in a new window]   FIGURE 5. Summed images of patient 15 from 150 to 350 s after intravenous injection of 80 MBq of 99mTc-mebrofenin preoperatively (A), 1 d postoperatively after left-sided hemihepatectomy (B), and 3 mo postoperatively (C). Images are normalized to the preoperative HBS. In A, an ROI is drawn over the entire liver (black), the future remnant liver (white), and the mediastinal blood pool (bl). The ROIs were copied on the HBS performed 1 d and 3 mo postoperatively. The total liver function was 10.30%/min, and the RLF was estimated at 8.99%/min on preoperative HBS. The measured RLF 1 d postoperatively was 9.30%/min. After 3 mo, liver function recovered to 11.79%/min, with hypertrophy visible on HBS.