Bennink Roelof J, Dinant Sander, Erdogan Deha, Heijnen Bob H, Straatsburg Irene H, van Vliet Arlene K, van Gulik Thomas M
Department of Nuclear Medicine, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands.
J Nucl Med. 2004 Jun;45(6):965-71.
Hepatic resection is the therapy of choice for malignant and symptomatic benign hepatobiliary tumors. The concept of remnant liver volume (RLV) has been introduced and can be assessed with CT. However, inhomogeneous liver function distribution and a lack of correlation between morphologic hypertrophy and functional recovery fuelled the enthusiasm for functional imaging. The aim of the present study was to assess liver function reserve (LFR) and remnant liver function (RLF) before and after major liver surgery with hepatobiliary scintigraphy (HBS) and to compare scintigraphic results with volumetric CT data and indocyanine-green (ICG) clearance test results. Furthermore, HBS was used to assess functional recovery of liver function, and results were compared with volumetric data.
Fifteen patients with a partial liver resection were included. HBS was performed before, 1 d after, and 3 mo after surgery. ICG clearance and CT were performed before and 3 mo after surgery. Liver function determined with HBS was compared with ICG and volumetric data.
Liver function determination using HBS was highly reproducible. A strong positive association (r = 0.84) was found between LFR determined with HBS and ICG clearance. Little or no association (r = 0.27) was found between CT volumetric analysis and corresponding ICG clearance. A strong positive association (r = 0.95) was found between the RLF determined preoperatively on HBS and the actually measured value postoperatively. A weak positive association (r = 0.61) was found between functional liver regeneration and liver volume regeneration in the 3 mo after partial liver resection.
HBS offers a unique combination of functional liver uptake and excretion with the ability to assess the preoperative LFR and to estimate the RLF preoperatively. Determination of the RLF instead of the RLV might clarify some of the discrepancies observed in the literature between RLV and clinical outcome in patients with an inhomogeneous liver function. Finally, liver function regeneration can be monitored using HBS.
肝切除术是恶性和有症状良性肝胆肿瘤的首选治疗方法。残余肝体积（RLV）的概念已被引入，并且可以通过CT进行评估。然而，肝功能分布不均匀以及形态学肥大与功能恢复之间缺乏相关性，激发了人们对功能成像的热情。本研究的目的是通过肝胆闪烁显像（HBS）评估大肝手术后的肝功能储备（LFR）和残余肝功能（RLF），并将闪烁显像结果与容积CT数据和吲哚菁绿（ICG）清除试验结果进行比较。此外，HBS用于评估肝功能的功能恢复情况，并将结果与容积数据进行比较。
纳入15例接受部分肝切除术的患者。在手术前、术后1天和术后3个月进行HBS。在手术前和术后3个月进行ICG清除试验和CT检查。将通过HBS测定的肝功能与ICG和容积数据进行比较。
使用HBS测定肝功能具有高度可重复性。通过HBS测定的LFR与ICG清除率之间发现强烈的正相关（r = 0.84）。CT容积分析与相应的ICG清除率之间发现很少或没有相关性（r = 0.27）。术前通过HBS测定的RLF与术后实际测量值之间发现强烈的正相关（r = 0.95）。在部分肝切除术后3个月，功能性肝再生与肝体积再生之间发现弱正相关（r = 0.61）。
HBS提供了功能性肝摄取和排泄的独特组合，能够评估术前LFR并术前估计RLF。测定RLF而非RLV可能会澄清文献中观察到的肝功能不均匀患者RLV与临床结果之间的一些差异。最后，可以使用HBS监测肝功能再生。
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