Piron Lauranne, Deshayes Emmanuel, Cassinotto Christophe, Quenet François, Panaro Fabrizio, Hermida Margaux, Allimant Carole, Assenat Eric, Pageaux Georges-Philippe, Molinari Nicolas, Guiu Boris
Department of Radiology, St. Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France.
Department of Nuclear Medicine, Cancer Institute of Montpellier (ICM), 34090 Montpellier, France.
Diagnostics (Basel). 2020 Dec 23;11(1):12. doi: 10.3390/diagnostics11010012.
The objective was to assess the changes in regional volumes and functions under venous-impaired vascular conditions following liver preparation. Twelve patients underwent right portal vein embolization (PVE) ( = 5) or extended liver venous deprivation (eLVD, i.e., portal and right and middle hepatic veins embolization) ( = 7). Volume and function measurements of deportalized liver, venous-deprived liver and congestive liver were performed before and after PVE/eLVD at days 7, 14 and 21 using 99mTc-mebrofenin hepatobiliary scintigraphy with single-photon emission computed tomography and computed tomography (99mTc-mebrofenin SPECT-CT). Volume and function progressed independently in the deportalized liver ( = 0.47) with an early decrease in function (median -18.2% (IQR, -19.4--14.5) at day 7) followed by a decrease in volume (-19.3% (-22.6--14.4) at day 21). Volume and function progressed independently in the venous deprived liver ( = 0.80) with a marked and early decrease in function (-41.1% (-52.0--12.9) at day 7) but minimal changes in volume (-4.7% (-10.4-+3.9) at day 21). Volume and function progressed independently in the congestive liver ( = 0.21) with a gradual increase in volume (+43.2% (+38.3-+51.2) at day 21) that preceded a late and moderate increase in function at day 21 (+34.8% (-8.3-+46.6)), concomitantly to the disappearance of hypoattenuated congestive areas in segment IV (S4) on CT, initially observed in 6/7 patients after eLVD and represented 35.3% (22.2-46.4) of whole S4 volume. Liver volume and function progress independently whatever the vascular condition. Hepatic congestion from outflow obstruction drives volume increase but results in early impaired function.
目的是评估肝脏准备后静脉受损血管条件下区域体积和功能的变化。12例患者接受了右门静脉栓塞术（PVE）（n = 5）或扩大的肝静脉剥夺术（eLVD，即门静脉及右肝静脉和中肝静脉栓塞）（n = 7）。在PVE/eLVD后第7、14和21天，使用99m锝-美罗芬宁肝胆闪烁显像联合单光子发射计算机断层扫描和计算机断层扫描（99mTc-美罗芬宁SPECT-CT）对去门静脉化肝脏、静脉剥夺肝脏和充血性肝脏进行体积和功能测量。去门静脉化肝脏中体积和功能独立进展（r = 0.47），功能早期下降（第7天中位数为-18.2%（四分位间距，-19.4%--14.5%）），随后体积下降（第21天为-19.3%（-22.6%--14.4%））。静脉剥夺肝脏中体积和功能独立进展（r = 0.80），功能显著早期下降（第7天为-41.1%（-52.0%--12.9%）），但体积变化极小（第21天为-4.7%（-10.4%--3.9%））。充血性肝脏中体积和功能独立进展（r = 0.21），体积逐渐增加（第21天为+43.2%（+38.3%--51.2%）），随后在第21天功能出现晚期中度增加（+34.8%（-8.3%--46.6%）），同时CT上IV段（S4）低衰减充血区域消失，最初在7例eLVD患者中的6例中观察到，占整个S4体积的35.3%（22.2%--46.4%）。无论血管状况如何，肝脏体积和功能均独立进展。流出道梗阻引起的肝充血导致体积增加，但会导致早期功能受损。
