Espersen Caroline, Borgwardt Lise, Larsen Peter Nørgaard, Andersen Trine Borup, Stenholt Louise, Petersen Lars J
Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Gastrointestinal Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
EJNMMI Res. 2021 Aug 21;11(1):80. doi: 10.1186/s13550-021-00816-4.
BACKGROUND/AIMS: Although volumetric imaging by computed tomography (CT) is the gold standard for preoperative assessment of the future liver remnant, nuclear imaging studies have shown promising data. This systematic review summarized the results from trials investigating volumetric and nuclear medicine imaging for the prediction of postoperative mortality and liver failure (LF).
MEDLINE and Web of Science were searched for papers investigating nuclear imaging methods for the prediction of postoperative clinical outcomes in patients undergoing local, liver-directed treatments. Only papers investigating both preoperative nuclear imaging and CT or magnetic resonance imaging (MR) for the prediction of postoperative mortality and/or LF were included.
Twenty-five trials were qualified for this review. All trials but two used technetium-based tracers for the nuclear imaging examination. Four papers used MR imaging and the remaining used CT for the volumetric evaluation. Overall, the studies were heterogeneous both in terms of methodology and imaging technique. Of the thirteen studies reporting on postoperative mortality, most were descriptive without detailed diagnostic data. A few with detailed data found that nuclear imaging had better predictive value than volumetric imaging. Nineteen studies investigated the prediction of postoperative LF of which seven papers investigated the predictive value of both modalities in multivariable regression analysis. Two papers found that only nuclear imaging parameters were predictive of LF, one paper found that the CT parameter was predictive, and four papers found that combined nuclear and CT/MR imaging parameters were predictive of LF.
Both methodologies were useful in the preoperative assessment of patients scheduled for liver interventions, especially in combination, but nuclear imaging demonstrated better predictive value for postoperative mortality and LF in a few trials. The overall technical and methodological heterogeneity of the included studies complicates the ability to directly compare the clinical utility of the two imaging techniques.
背景/目的：尽管计算机断层扫描（CT）容积成像术是术前评估未来肝残余量的金标准，但核医学成像研究已显示出有前景的数据。本系统评价总结了关于容积成像和核医学成像预测术后死亡率和肝衰竭（LF）的试验结果。
检索MEDLINE和科学网，查找研究核医学成像方法预测接受局部肝脏定向治疗患者术后临床结局的论文。仅纳入同时研究术前核医学成像以及CT或磁共振成像（MR）预测术后死亡率和/或LF的论文。
25项试验符合本评价标准。除两项试验外，所有试验均使用锝类示踪剂进行核医学成像检查。4篇论文使用MR成像，其余使用CT进行容积评估。总体而言，这些研究在方法和成像技术方面均存在异质性。在13项报告术后死亡率的研究中，大多数是描述性的，没有详细的诊断数据。少数有详细数据的研究发现核医学成像比容积成像具有更好的预测价值。19项研究调查了术后LF的预测情况，其中7篇论文在多变量回归分析中研究了两种方法的预测价值。2篇论文发现只有核医学成像参数可预测LF，1篇论文发现CT参数可预测，4篇论文发现核医学成像与CT/MR成像参数联合可预测LF。
两种方法在计划进行肝脏干预的患者术前评估中均有用，尤其是联合使用时，但在少数试验中核医学成像对术后死亡率和LF显示出更好的预测价值。纳入研究的总体技术和方法异质性使得直接比较两种成像技术的临床效用变得复杂。
