Kozaki Yoichi, Ichikawa Yasutaka, Nakamura Satoshi, Kobayashi Tatsuhiro, Tomita Yoya, Nagata Motonori, Kuriyama Naohisa, Mizuno Shugo, Sakuma Hajime
Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, 514-8507, Mie, Japan.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Hospital, 2- 174 Edobashi, Tsu, 514-8507, Mie, Japan.
Mol Imaging Biol. 2024 Dec;26(6):1027-1035. doi: 10.1007/s11307-024-01958-2. Epub 2024 Oct 10.
To evaluate the value of Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (Tc-GSA) single photon emission computed tomography (SPECT) for assessing liver fibrosis, and to assess its complementary value to other liver function indices such as fibrosis-4 (FIB-4) index and indocyanine green (ICG) clearance test parameters (ICG-R15 and ICG-K).
Seventy-eight patients with chronic liver disease and hepatocellular carcinoma who underwent Tc-GSA scintigraphy and other liver function tests including ICG test and FIB-4 index prior to hepatectomy were studied. Tc-GSA imaging was performed with SPECT/CT scanner (Discovery NM/CT 670). Immediately after injection of Tc-GSA, dynamic imaging was performed for 20 min, followed by SPECT data acquisition for 6 min. LHL15 which is a conventional index by Tc-GSA planar images, and liver uptake ration (LUR) was measured from Tc-GSA SPECT images. From the liver resection specimens, the degree of liver fibrosis was graded according to the Ludwig scale (F0-4).
Significant differences in LUR, LHL15, ICG-R15, ICG-K, platelet count and FIB-4 index were found between the F0-3 and F4 liver fibrosis patient groups (P < 0.05). Multivariate logistic regression analysis revealed that LUR and ICG-K were independent factors for identifying severe liver fibrosis (F4). Area under the curve of receiver operating curve analysis for the logistic regression model using LUR and ICG-K was 0.83. In the patient group with higher FIB-4 (≥ 3.16), the diagnostic performance of LUR for detecting severe liver fibrosis was significantly better than LHL15 (AUC: 0.83 vs. 0.75, P = 0.048). In the high FIB-4 index group, the sensitivity and specificity for identifying F4 was 88% and 85%, respectively, with LUR cutoff value of 41.2%.
LUR, measured by Tc-GSA SPECT, is a useful indicator for identifying sever liver fibrosis. Particularly in patients with high FIB-4 index (≥ 3.16), LUR can be a valuable indicator to identify severe liver fibrosis with high diagnostic accuracy.
评估锝-99m-二乙烯三胺五乙酸-半乳糖基人血清白蛋白（Tc-GSA）单光子发射计算机断层扫描（SPECT）在评估肝纤维化中的价值，并评估其对其他肝功能指标（如纤维化-4（FIB-4）指数和吲哚菁绿（ICG）清除试验参数（ICG-R15和ICG-K））的补充价值。
研究了78例慢性肝病和肝细胞癌患者，这些患者在肝切除术前接受了Tc-GSA闪烁扫描及包括ICG试验和FIB-4指数在内的其他肝功能检查。使用SPECT/CT扫描仪（Discovery NM/CT 670）进行Tc-GSA成像。注射Tc-GSA后立即进行20分钟的动态成像，随后进行6分钟的SPECT数据采集。从Tc-GSA平面图像测量传统指标LHL15，并从Tc-GSA SPECT图像测量肝脏摄取率（LUR）。根据Ludwig分级标准（F0-4）对肝切除标本的肝纤维化程度进行分级。
F0-3组和F4组肝纤维化患者在LUR、LHL15、ICG-R15、ICG-K、血小板计数和FIB-4指数方面存在显著差异（P<0.05）。多因素逻辑回归分析显示，LUR和ICG-K是识别严重肝纤维化（F4）的独立因素。使用LUR和ICG-K的逻辑回归模型的受试者操作曲线分析的曲线下面积为0.83。在FIB-4较高（≥3.16）的患者组中，LUR检测严重肝纤维化的诊断性能明显优于LHL15（AUC：0.83对0.75，P=0.048）。在高FIB-4指数组中，LUR识别F4的敏感性和特异性分别为88%和85%，截断值为41.2%。
通过Tc-GSA SPECT测量的LUR是识别严重肝纤维化的有用指标。特别是在FIB-4指数较高（≥3.16）的患者中，LUR可以作为一个有价值的指标，以高诊断准确性识别严重肝纤维化。
