Tatsuaki Sumiyoshi1, Takehiro Okabayashi2, Yuji Negoro3, Yasuhiro Hata4, Yoshihiro Noda4, Kenta Sui2, Jun Iwata5, Manabu Matsumoto5. 1. Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125 Ike, Kochi, Japan. tasu050520@yahoo.co.jp. 2. Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125 Ike, Kochi, Japan. 3. Department of Medical Oncology, Kochi Health Sciences Center, Kochi, Japan. 4. Department of Radiology, Kochi Health Sciences Center, Kochi, Japan. 5. Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi, Japan.
Abstract
PURPOSE: The value of indocyanine green (ICG) test is negatively affected in patients with intrahepatic shunt, ICG excretory defect, or jaundice. This study evaluated 99mTc-GSA SPECT/CT fusion imaging for assessing liver function in patients with severely deteriorated ICG values. MATERIALS AND METHODS: Thirteen hepatectomy candidates with ICG retention rates over 40% were retrospectively analyzed. The ICG clearance rate (KICG) and estimated KICG obtained by 99mTc-GSA scintigraphy (KGSA) were used to evaluate preoperative whole liver function. Remnant liver function was assessed using the remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) indices; hepatectomy was considered unsafe for values < 0.05. The correlations of remKICG and remKGSA with postoperative mortality and morbidity were also investigated. RESULTS: KGSA values were significantly greater than KICG values (median: 0.12 vs. 0.059; p < 0.01); remKGSA values were greater than remKICG values in all patients (median: 0.107 vs. 0.0413; p < 0.01). Hepatectomy was considered unsafe in 70% patients using remKICG, and in none of those using remKGSA; liver failure or postoperative mortality did not occur. CONCLUSIONS: 99mTc-GSA SPECT/CT fusion imaging enables more accurate liver function assessment than the ICG test in patients with severely deteriorated ICG values.
PURPOSE: The value of indocyanine green (ICG) test is negatively affected in patients with intrahepatic shunt, ICG excretory defect, or jaundice. This study evaluated 99mTc-GSA SPECT/CT fusion imaging for assessing liver function in patients with severely deteriorated ICG values. MATERIALS AND METHODS: Thirteen hepatectomy candidates with ICG retention rates over 40% were retrospectively analyzed. The ICG clearance rate (KICG) and estimated KICG obtained by 99mTc-GSA scintigraphy (KGSA) were used to evaluate preoperative whole liver function. Remnant liver function was assessed using the remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) indices; hepatectomy was considered unsafe for values < 0.05. The correlations of remKICG and remKGSA with postoperative mortality and morbidity were also investigated. RESULTS: KGSA values were significantly greater than KICG values (median: 0.12 vs. 0.059; p < 0.01); remKGSA values were greater than remKICG values in all patients (median: 0.107 vs. 0.0413; p < 0.01). Hepatectomy was considered unsafe in 70% patients using remKICG, and in none of those using remKGSA; liver failure or postoperative mortality did not occur. CONCLUSIONS: 99mTc-GSA SPECT/CT fusion imaging enables more accurate liver function assessment than the ICG test in patients with severely deteriorated ICG values.
Entities:
Keywords:
Hepatectomy; Indocyanine green; Tc-99m-diethylenetriamine-pentaacetic acid-galactosyl human serum albumin single-photon emission computed tomography
Authors: Y Yumoto; T Yagi; S Sato; K Nouso; Y Kobayashi; M Ohmoto; E Yumoto; I Nagaya; H Nakatsukasa Journal: Br J Surg Date: 2010-06 Impact factor: 6.939