Sumiyoshi Tatsuaki, Okabayashi Takehiro, Negoro Yuji, Hata Yasuhiro, Noda Yoshihiro, Sui Kenta, Iwata Jun, Matsumoto Manabu
Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125 Ike, Kochi, Japan.
Department of Medical Oncology, Kochi Health Sciences Center, Kochi, Japan.
Jpn J Radiol. 2018 Sep;36(9):537-543. doi: 10.1007/s11604-018-0753-0. Epub 2018 Jun 12.
The value of indocyanine green (ICG) test is negatively affected in patients with intrahepatic shunt, ICG excretory defect, or jaundice. This study evaluated Tc-GSA SPECT/CT fusion imaging for assessing liver function in patients with severely deteriorated ICG values.
Thirteen hepatectomy candidates with ICG retention rates over 40% were retrospectively analyzed. The ICG clearance rate (KICG) and estimated KICG obtained by Tc-GSA scintigraphy (KGSA) were used to evaluate preoperative whole liver function. Remnant liver function was assessed using the remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) indices; hepatectomy was considered unsafe for values < 0.05. The correlations of remKICG and remKGSA with postoperative mortality and morbidity were also investigated.
KGSA values were significantly greater than KICG values (median: 0.12 vs. 0.059; p < 0.01); remKGSA values were greater than remKICG values in all patients (median: 0.107 vs. 0.0413; p < 0.01). Hepatectomy was considered unsafe in 70% patients using remKICG, and in none of those using remKGSA; liver failure or postoperative mortality did not occur.
Tc-GSA SPECT/CT fusion imaging enables more accurate liver function assessment than the ICG test in patients with severely deteriorated ICG values.
肝内分流、吲哚菁绿（ICG）排泄缺陷或黄疸患者的ICG试验价值受到负面影响。本研究评估了Tc-GSA SPECT/CT融合成像在评估ICG值严重恶化患者肝功能方面的作用。
回顾性分析了13例ICG潴留率超过40%的肝切除候选患者。采用ICG清除率（KICG）和通过Tc-GSA闪烁扫描获得的估计KICG（KGSA）来评估术前全肝功能。使用残余（rem）KICG（=KICG×体积率）和remKGSA（=KGSA×功能率）指标评估残余肝功能；对于值<0.05的情况，肝切除术被认为不安全。还研究了remKICG和remKGSA与术后死亡率和发病率的相关性。
KGSA值显著高于KICG值（中位数：0.12对0.059；p<0.01）；所有患者的remKGSA值均高于remKICG值（中位数：0.107对0.0413；p<0.01）。使用remKICG时，70%的患者肝切除术被认为不安全，而使用remKGSA时无一例被认为不安全；未发生肝衰竭或术后死亡。
对于ICG值严重恶化的患者，Tc-GSA SPECT/CT融合成像比ICG试验能更准确地评估肝功能。
