Cho Arthur, Chung Yong Eun, Choi Jin Sub, Kim Kyung Sik, Choi Gi Hong, Park Young Nyun, Kim Myeong-Jin
1 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
2 Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.
AJR Am J Roentgenol. 2017 Mar;208(3):624-631. doi: 10.2214/AJR.16.16450. Epub 2016 Dec 27.
The objective of our study was to investigate the prognostic value of total glycolysis of the remnant liver, which reflects both metabolic and anatomic liver function, for predicting postoperative hepatic insufficiency.
Patients who underwent F-FDG PET/CT and abdominal CT within 1 month of major hepatectomy were retrospectively analyzed. Total liver volume, remnant liver volume, the ratio of the remnant hepatic volume to the preoperative hepatic volume (RFRHV), and mean standardized uptake value (SUV) were measured, and total glycolysis of the remnant liver was calculated. Clinical hepatic function reserve values, including the indocyanine green retention rate at 15 minutes, the model for end-stage liver disease (MELD) score, and aspartate aminotransferase to platelet ratio index (APRI), were calculated. Univariate and multivariate analyses were performed, and an optimal model for predicting hepatic insufficiency was developed. ROC curves were used to compare diagnostic performance.
Of 149 patients, seven patients had hepatic insufficiency. The SUV showed the highest sensitivity (100%; specificity, 31.7%) for predicting hepatic insufficiency, and total glycolysis of the remnant liver showed the highest specificity (96.5%; sensitivity, 57.1%) for predicting hepatic insufficiency. On multivariate analysis, the odds ratio of APRI (> 5.4) and total glycolysis of the remnant liver (≤ 625.6) was 46.3 and 82.9, respectively, for predicting hepatic insufficiency. On ROC curve analysis, a new model composed of APRI and total glycolysis of the remnant liver showed a higher area under the ROC curve (A) value (A = 0.899) than SUV (0.659), MELD score (0.618), APRI (0.693), RFRHV (0.797), and remnant liver volume (0.762).
The total glycolysis of the remnant liver has moderate sensitivity and high specificity for predicting hepatic insufficiency. Combining the total glycolysis of the remnant liver and APRI yielded the best diagnostic performance for predicting hepatic insufficiency.
本研究旨在探讨反映代谢和解剖肝功能的残余肝总糖酵解对预测术后肝衰竭的预后价值。
对在大肝切除术后1个月内接受F-FDG PET/CT和腹部CT检查的患者进行回顾性分析。测量全肝体积、残余肝体积、残余肝体积与术前肝体积之比（RFRHV）以及平均标准化摄取值（SUV），并计算残余肝的总糖酵解。计算临床肝功能储备值，包括15分钟吲哚菁绿滞留率、终末期肝病模型（MELD）评分以及天冬氨酸转氨酶与血小板比值指数（APRI）。进行单因素和多因素分析，并建立预测肝衰竭的最佳模型。采用ROC曲线比较诊断性能。
149例患者中，7例发生肝衰竭。SUV对预测肝衰竭的敏感性最高（100%；特异性为31.7%），残余肝总糖酵解对预测肝衰竭的特异性最高（96.5%；敏感性为57.1%）。多因素分析显示，对于预测肝衰竭，APRI（>5.4）和残余肝总糖酵解（≤625.6）的比值比分别为46.3和82.9。ROC曲线分析显示，由APRI和残余肝总糖酵解组成的新模型的ROC曲线下面积（A）值（A = 0.899）高于SUV（0.659）、MELD评分（0.618）、APRI（0.693）、RFRHV（0.797）和残余肝体积（0.762）。
残余肝总糖酵解对预测肝衰竭具有中等敏感性和高特异性。将残余肝总糖酵解与APRI相结合对预测肝衰竭具有最佳诊断性能。
Zotero 插件