Tc-半乳糖基人血清白蛋白闪烁显像对肝切除术后肝衰竭的预测性。

Predictability of Tc-Galactosyl Human Serum Albumin Scintigraphy for Posthepatectomy Liver Failure.

机构信息

1 Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan.

2 Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

出版信息

AJR Am J Roentgenol. 2018 Jan;210(1):158-165. doi: 10.2214/AJR.17.18411. Epub 2017 Oct 12.

DOI:10.2214/AJR.17.18411

PMID:29023153

Abstract

OBJECTIVE

Posthepatectomy liver failure (PHLF) is one of the most serious complications after hepatectomy. The objective of the present study is to assess the potential diagnostic ability of Tc-galactosyl human serum albumin (GSA) scintigraphy to predict PHLF as defined by the International Study Group of Liver Surgery (ISGLS).

MATERIALS AND METHODS

Data from 100 patients who underwent Tc-GSA scintigraphy and subsequent hepatectomy were retrospectively analyzed. The blood clearance ratio (HH15), hepatic uptake ratio (LHL15), and maximal removal rate (Rmax) of Tc-GSA (GSA-Rmax) were calculated as scintigraphic parameters for the total liver. In addition to the ratio of preoperatively estimated remnant liver (ERL) counts to total liver counts (rERL-GSA), the ratio of actual remnant liver (ARL) counts to total liver counts (rARL-GSA), determined by applying a more accurate resection line with reference to both pre- and postoperative CT, was obtained from SPECT images. Functional remnant liver parameters of ERL-LHL15 (LHL15 of the estimated remnant liver), ERL-Rmax (maximal removal rate of estimated remnant liver counts), ARL-LHL15 (LHL15 of the actual remnant liver), and ARL-Rmax (maximal removal rate of actual remnant liver counts) were calculated using these values. ROC analysis was performed to evaluate the ability of these parameters to predict PHLF. Multivariate analysis was performed to identify independent predictors of PHLF.

RESULTS

PHLF occurred in 33 patients. Each of the ARL parameters had a significantly higher diagnostic performance compared with the corresponding ERL parameter (AUC values: for rARL-GSA vs rERL-GSA, 0.77 vs 0.62 [p = 0.0004]; for ARL-LHL15 vs ERL-LHL15, 0.79 vs 0.64 [p = 0.0005]; and for ARL-Rmax vs ERL-Rmax, 0.78 vs 0.66 [p = 0.0003]). According to multivariate analysis, each of three ARL parameters was identified as an independent predictor of PHLF (p < 0.0001 for all).

CONCLUSION

Technetium-99m-labeled GSA scintigraphy is useful for predicting PHLF, particularly for applying an accurate resection line on GSA-SPECT images.

摘要

目的

肝切除术后肝功能衰竭（PHLF）是肝切除术后最严重的并发症之一。本研究的目的是评估 Tc-半乳糖化人血清白蛋白（GSA）闪烁扫描术预测国际肝脏外科研究组（ISGLS）定义的 PHLF 的潜在诊断能力。

材料与方法

回顾性分析了 100 例接受 Tc-GSA 闪烁扫描术和随后肝切除术的患者的数据。计算 Tc-GSA 的血清除率比（HH15）、肝摄取率（LHL15）和最大清除率（GSA-Rmax）作为总肝的闪烁扫描参数。除了术前估计残余肝（ERL）计数与总肝计数之比（rERL-GSA）外，还从 SPECT 图像中获得了更准确的参考术前和术后 CT 切除线的实际残余肝（ARL）计数与总肝计数之比（rARL-GSA）。使用这些值计算 ERL-LHL15（估计残余肝的 LHL15）、ERL-Rmax（估计残余肝计数的最大清除率）、ARL-LHL15（实际残余肝的 LHL15）和 ARL-Rmax（实际残余肝计数的最大清除率）的功能性残余肝参数。进行 ROC 分析以评估这些参数预测 PHLF 的能力。进行多变量分析以确定 PHLF 的独立预测因子。

结果

33 例患者发生 PHLF。每个 ARL 参数的诊断性能均明显高于相应的 ERL 参数（AUC 值：rARL-GSA 与 rERL-GSA 相比，0.77 与 0.62 [p = 0.0004]；ARL-LHL15 与 ERL-LHL15 相比，0.79 与 0.64 [p = 0.0005]；以及 ARL-Rmax 与 ERL-Rmax 相比，0.78 与 0.66 [p = 0.0003]）。根据多变量分析，三个 ARL 参数中的每一个均被确定为 PHLF 的独立预测因子（所有均为 p < 0.0001）。