Mitsumori A, Nagaya I, Kimoto S, Akaki S, Togami I, Takeda Y, Joja I, Hiraki Y
Department of Radiology, Okayama University Medical School, Japan.
Eur J Nucl Med. 1998 Oct;25(10):1377-82. doi: 10.1007/s002590050311.
It is extremely important to have a good grasp of the acceptable limit of hepatectomy before operation because postoperative liver failure can take a fatal course; however, baseline data on the limit of hepatectomy have not been clearly defined. We therefore evaluated and compared the predicted remnant liver function obtained by computed tomography(CT) and technetium-99m diethylenetriamine penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy in order to obtain precise data regarding remnant liver function before hepatectomy. We investigated 20 patients undergoing hepatectomy using the clearance rate of indocyanine green (KICG) as a parameter, and compared the predicted postoperative KICG obtained by CT and by transaxial single-photon emission tomographic (SPET) images acquired by 99mTc GSA liver scintigraphy before hepatectomy. In GSA studies, based on time-activity curves for the heart and liver, we compared HH15 (heart activity at 15 min divided by heart activity at 3 min), LHL15 (liver activity at 15 min divided by heart plus liver activity at 15 min) and KL (obtained from the time-activity curve for the liver) in 103 patients. In 58 patients without increased serum bilirubin, KL was compared with KICG. In four patients, occlusion of the right portal vein was performed with the aim of carrying out secondary hepatectomy, and changes in liver volume were compared between CT and 99mTc GSA liver scintigraphy. The correlation coefficient between the postoperative KICG predicted by CT and the actual postoperative KICG was rather poor, at r = 0.569 (P < 0.05); that between the postoperative KICG predicted by 99mTc GSA liver scintigraphy and the actual postoperative KICG was good, at r = 0.788 (P < 0.01); correlations between KL and HH15 and between KL and LHL15 in 103 patients were very good or good, at r = 0.906 (P < 0.001) and r = 0.807 (P < 0.001), respectively, and that between KL and KICG in 58 patients was very good, at r = 0.916 (P < 0.001). In all four cases of right portal vein occlusion, the remnant liver volume ratio was markedly increased after occlusion in GSA compared with CT, and the postoperative KICG predicted by GSA after occlusion was closer to the actual postoperative KICG than that predicted by CT. It is concluded that 99mTc GSA liver scintigraphy is useful for predicting remnant liver function before hepatectomy and for evaluating changes in regional liver function after occlusion of the portal vein unilaterally.
术前掌握肝切除的可接受限度极为重要，因为术后肝衰竭可能会导致致命后果；然而，肝切除限度的基线数据尚未明确界定。因此，我们评估并比较了通过计算机断层扫描（CT）和锝-99m二乙三胺五乙酸-半乳糖基人血清白蛋白（99mTc-GSA）肝脏闪烁显像获得的预测残余肝功能，以便在肝切除术前获得有关残余肝功能的精确数据。我们以吲哚菁绿清除率（KICG）为参数，对20例行肝切除术的患者进行了研究，并比较了术前通过CT以及99mTc GSA肝脏闪烁显像获得的经轴位单光子发射断层扫描（SPET）图像预测的术后KICG。在GSA研究中，根据心脏和肝脏的时间-活性曲线，我们比较了103例患者的HH15（15分钟时的心脏活性除以3分钟时的心脏活性）、LHL15（15分钟时的肝脏活性除以15分钟时的心脏加肝脏活性）和KL（从肝脏的时间-活性曲线获得）。在58例血清胆红素未升高的患者中，比较了KL与KICG。在4例患者中，为了进行二期肝切除术而进行了右门静脉闭塞，并比较了CT和99mTc GSA肝脏闪烁显像之间肝脏体积的变化。CT预测的术后KICG与实际术后KICG之间的相关系数相当低，r = 0.569（P < 0.05）；99mTc GSA肝脏闪烁显像预测的术后KICG与实际术后KICG之间的相关性良好，r = 0.788（P < 0.01）；103例患者中KL与HH15之间以及KL与LHL15之间的相关性非常好或良好，分别为r = 0.906（P < 0.001）和r = 0.807（P < 0.001），58例患者中KL与KICG之间的相关性非常好，r = 0.916（P < 0.001）。在所有4例右门静脉闭塞病例中，与CT相比，GSA显示闭塞后残余肝脏体积比明显增加，并且闭塞后GSA预测的术后KICG比CT预测的更接近实际术后KICG。结论是，99mTc GSA肝脏闪烁显像有助于预测肝切除术前的残余肝功能，并评估单侧门静脉闭塞后区域肝功能的变化。
