Chan YeeMei, Luk WingHang, Cheng LikFai, Chan HoFung, Pan N Y, Ma KaFai
Department of Diagnostic Radiology, LG1, Princess Margaret Hospital, Lai King Hill Road, Hong Kong.
Department of Diagnostic Radiology, LG1, Princess Margaret Hospital, Lai King Hill Road, Hong Kong.
Int J Surg Case Rep. 2019;62:89-93. doi: 10.1016/j.ijscr.2019.08.009. Epub 2019 Aug 17.
Quantitative assessment is an essential tool in determining the proportion of liver to be reserved before lobectomy. Technetium-99 m sulfur colloid single-photon emission computed tomography (Tc-99 m SC SPECT-CT) can help in the quantitative assessment of functioning liver tissues and percentage of liver reserve before segmentectomy and lobectomy Matesan et al. (2017), Bowen et al. (2016) and Lam et al. (2013).
A 64-year-old man with alcoholic cirrhosis was admitted to our hospital with a 15 × 10 x 13 cm bilobar HCC. Y90 radioembolization was utilized to downstage the liver tumor. On follow-up CT scan of the liver after radiotherapy, the HCC was much reduced to 6.5 cm in size but still viable with elevated alpha fetoprotein ([AFP] from 225 to 381 to 959 ng/mL). Resection was considered. Constitutional indocyanine green retention at 15 min (ICG-R-15) was 22%. We introduced the Tc-99 m SC SPECT-CT scan in order to assess the percentage liver function of each lobe. It showed minimal uptake in the remaining functioning right lobe with a hypertrophic left lobe to whole liver uptake ratio of 87.1%. This finding gave us confidence to perform right hepatectomy.
We used Tc-99 m SC SPECT-CT to estimate the normal functional liver reserve after Y90 radioembolization of a hepatocellular carcinoma (HCC). To our understanding, it is the first case report using Tc-99 m SC to predict the percentage of functional liver reserve after yttrium-90 (Y90) radioembolization.
Tc-99 m SC SPECT-CT is a novel helper used to assess the differential liver function after Y90 radioembolization of HCC and before segmentectomy and lobectomy of the liver.
定量评估是确定肝叶切除术前保留肝组织比例的重要工具。锝-99m硫胶体单光子发射计算机断层扫描（Tc-99m SC SPECT-CT）有助于在肝段切除术和肝叶切除术之前对功能性肝组织和肝储备百分比进行定量评估（马泰桑等人，2017年；鲍恩等人，2016年；林等人，2013年）。
一名64岁的酒精性肝硬化男性因15×10×13 cm的双叶肝癌入住我院。采用钇-90（Y90）放射性栓塞术使肝肿瘤降期。放疗后肝脏的随访CT扫描显示，肝癌大小大幅缩小至6.5 cm，但仍存活，甲胎蛋白（[AFP]）从225 ng/mL升至381 ng/mL，再升至959 ng/mL。考虑进行手术切除。15分钟时的靛氰绿滞留率（ICG-R-15）为22%。我们引入Tc-99m SC SPECT-CT扫描以评估各肝叶的肝功能百分比。结果显示，剩余的功能性右叶摄取极少，左叶肥大，左叶与全肝摄取比为87.1%。这一发现使我们有信心进行右半肝切除术。
我们使用Tc-99m SC SPECT-CT来估计肝细胞癌（HCC）经Y90放射性栓塞术后的正常功能性肝储备。据我们所知，这是首例使用Tc-99m SC预测钇-90（Y90）放射性栓塞术后功能性肝储备百分比的病例报告。
Tc-99m SC SPECT-CT是一种新型辅助手段，用于评估HCC经Y90放射性栓塞术后以及肝段切除术和肝叶切除术之前的肝差异功能。
