de Vries Kirsten, Oor Jelmer E, Fouraschen Suomi M G, de Boer Marieke T, Nijkamp Maarten W, Jebbink Erik Groot, Stormezand Gilles N, Ruiter Simeon J S
Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, 9713 GZ, the Netherlands.
Technical Medicine, University of Twente, Enschede, the Netherlands, Drienerlolaan 5, 7522 NB, Overijssel.
EJNMMI Res. 2025 Jun 12;15(1):68. doi: 10.1186/s13550-025-01261-3.
Post-hepatectomy liver failure (PHLF) is a serious complication following hepatic resection and associated with a high mortality rate. The risk of PHLF can be estimated pre-resection by assessing the function of the future liver remnant (FLR) using hepatobiliary scintigraphy (HBS). Inaccurate estimation can have profound consequences, including an incorrect decision whether or not to proceed with hepatic resection. Therefore, it is essential to determine the reproducibility of preoperative assessment of the FLR function using HBS. The interobserver variability in the assessments of FLR function between two independent observers, blinded for each other’s results, was evaluated.
In 24 out of 50 patients, the FLR function was predicted to be sufficient (> 2.69%/min/m) to proceed with hepatic resection without preoperative FLR hypertrophy-inducing measures. In contrast, six patients were first subjected to portal vein embolization based on a predicted insufficient FLR function, which subsequently resulted in resection in four patients. Comparing the FLR function analyses of both observers, Bland-Altman plots demonstrated that most assessments lie within the 95% confidence interval and no pattern suggesting bias was observed. The interobserver level of agreement therefore appeared high for the FLR function (ICC = 0.996, Spearman’s ρ = 0.995 and Cohen’s κ = 0.948).
This study shows a high interobserver agreement and a negligible interobserver variability in the assessment of FLR function using HBS, regardless of the extent of observer experience. Therefore, the preoperative assessment of the FLR function is reproducible in the workup for patients planned to undergo (major) hepatic resections.
The online version contains supplementary material available at 10.1186/s13550-025-01261-3.
肝切除术后肝衰竭（PHLF）是肝切除术后的一种严重并发症，死亡率很高。术前可通过肝胆闪烁显像（HBS）评估未来肝残余（FLR）的功能来估计PHLF的风险。估计不准确可能会产生深远影响，包括决定是否进行肝切除的错误决策。因此，确定使用HBS对FLR功能进行术前评估的可重复性至关重要。评估了两名相互不知道对方结果的独立观察者在评估FLR功能时的观察者间变异性。
50例患者中有24例预测FLR功能足够（>2.69%/min/m），可在不采取术前FLR肥大诱导措施的情况下进行肝切除。相比之下，6例患者最初因预测FLR功能不足而接受门静脉栓塞，其中4例随后进行了切除。比较两位观察者的FLR功能分析，Bland-Altman图显示大多数评估值在95%置信区间内，未观察到提示偏差的模式。因此，观察者间对FLR功能的一致性水平似乎很高（ICC = 0.996，Spearman's ρ = 0.995，Cohen's κ = 0.948）。
本研究表明，无论观察者经验程度如何，使用HBS评估FLR功能时观察者间一致性高，观察者间变异性可忽略不计。因此，对于计划进行（大）肝切除的患者，术前对FLR功能的评估在检查中是可重复的。
在线版本包含可在10.1186/s13550-025-01261-3获取的补充材料。
