Iida Masatake, Yamamoto Yuzo, Katoh Hiroki, Taniguchi Naoto, Abe Yuki, Kumagai Kenta, Uchinami Hiroshi
Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Akita, Japan.
Division of Diagnostic Radiology, Akita University Hospital, Akita, Japan.
Surg Open Sci. 2022 Jan 15;8:1-8. doi: 10.1016/j.sopen.2021.12.001. eCollection 2022 Apr.
The significance of incorporating regional functional heterogeneity assessment by liver scintigraphy into the calculation of the future liver remnant has been reported. However, liver scintigraphy entails additional costs and radiation exposure. Nevertheless, studies describing when liver scintigraphy demonstrates an actual benefit over computed tomography liver volumetry are lacking. Thus, we evaluated the degree of agreement between future liver remnant % values calculated by technetium Tc diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy (galactosyl human serum albumin-based future liver remnant %) and those by computed tomography volumetry and investigated the practical impact of performing regional functional heterogeneity assessment.
The Bland-Altman method was used to retrospectively analyze the agreement between computed tomography- and galactosyl human serum albumin-based future liver remnant % measurements in 84 patients.
In ordinary patients with a computed tomography-based future liver remnant % greater than 50%, there was a good agreement between both measurements. However, in cases with a computed tomography-based future liver remnant % less than 40%, galactosyl human serum albumin-based measurements were significantly smaller than computed tomography-based values, with 88% of these patients exhibiting a galactosyl human serum albumin-based future liver remnant % less than 30%. After portal vein embolization, galactosyl human serum albumin-based measurements were primarily greater than or in agreement with computed tomography-based values, even in cases with a computed tomography-based future liver remnant % less than 40%.
Adding Tc diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy to computed tomography liver volumetry is advised when deciding on hepatectomy in patients with a computed tomography-based future liver remnant % less than 50%. If the computed tomography-based future liver remnant % is smaller than 40%, it is strongly recommended to check future liver remnant % by Tc diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy. In other cases, computed tomography-based future liver remnant % calculation alone can be regarded as the gold standard of safe hepatectomy.
已有报道称，将肝脏闪烁扫描法进行的区域功能异质性评估纳入未来肝残余量的计算具有重要意义。然而，肝脏闪烁扫描法会带来额外费用和辐射暴露。尽管如此，目前仍缺乏关于肝脏闪烁扫描法相较于计算机断层扫描肝脏容积测量法何时能显示出实际益处的研究。因此，我们评估了锝 Tc 二乙三胺五乙酸 - 半乳糖基人血清白蛋白闪烁扫描法（基于半乳糖基人血清白蛋白的未来肝残余量百分比）与计算机断层扫描容积测量法所计算出的未来肝残余量百分比值之间的一致性程度，并研究了进行区域功能异质性评估的实际影响。
采用 Bland - Altman 方法对 84 例患者基于计算机断层扫描和基于半乳糖基人血清白蛋白的未来肝残余量百分比测量值之间的一致性进行回顾性分析。
在基于计算机断层扫描的未来肝残余量百分比大于 50%的普通患者中，两种测量方法之间具有良好的一致性。然而，在基于计算机断层扫描的未来肝残余量百分比小于 40%的病例中，基于半乳糖基人血清白蛋白的测量值显著小于基于计算机断层扫描的值，其中 88%的此类患者基于半乳糖基人血清白蛋白的未来肝残余量百分比小于 30%。门静脉栓塞后，即使在基于计算机断层扫描的未来肝残余量百分比小于 40%的病例中，基于半乳糖基人血清白蛋白的测量值主要大于或与基于计算机断层扫描的值一致。
对于基于计算机断层扫描的未来肝残余量百分比小于 50%的患者，在决定肝切除时，建议在计算机断层扫描肝脏容积测量基础上增加锝 Tc 二乙三胺五乙酸 - 半乳糖基人血清白蛋白闪烁扫描法。如果基于计算机断层扫描的未来肝残余量百分比小于 40%，强烈建议通过锝 Tc 二乙三胺五乙酸 - 半乳糖基人血清白蛋白闪烁扫描法检查未来肝残余量百分比。在其他情况下，仅基于计算机断层扫描的未来肝残余量百分比计算可被视为安全肝切除的金标准。
