Assessment of Future Remnant Liver Function Using Hepatobiliary Scintigraphy in Patients Undergoing Major Liver Resection

• Published in: Journal of gastrointestinal surgery Vol. 14; no. 2; pp. 369 - 378
• Main Authors: de Graaf, Wilmar, van Lienden, Krijn P., Dinant, Sander, Roelofs, Joris J. T. H., Busch, Olivier R. C., Gouma, Dirk J., Bennink, Roelof J., van Gulik, Thomas M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.02.2010; Springer Nature B.V
• Subjects: Aniline Compounds; Gastroenterology; Glycine; Hepatectomy - adverse effects; Humans; Hyperglycemia; Imino Acids; Liver - diagnostic imaging; Liver - physiopathology; Liver cirrhosis; Liver Failure - diagnostic imaging; Liver Failure - etiology; Medicine; Medicine & Public Health; Organ Size; Organotechnetium Compounds; Original; Original Article; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Surgery; Liver volume; Liver function; Liver failure; Mebrofenin; CT volumetry; Hepatectomy
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-009-1085-2

Background 99m Tc-mebrofenin hepatobiliary scintigraphy (HBS) was used as a quantitative method to evaluate liver function. The aim of this study was to compare future remnant liver function assessed by 99m Tc-mebrofenin hepatobiliary scintigraphy with future remnant liver volume in the prediction of liver failure after major liver resection. Methods Computed tomography (CT) volumetry and 99m Tc-mebrofenin hepatobiliary scintigraphy were performed prior to major resection in 55 high-risk patients, including 30 patients with parenchymal liver disease. Liver volume was expressed as percentage of total liver volume or as standardized future remnant liver volume. Receiver operating characteristic (ROC) curve analysis was performed to identify a cutoff value for future remnant liver function in predicting postoperative liver failure. Results Postoperative liver failure occurred in nine patients. A liver function cutoff value of 2.69%/min/m 2 was calculated by ROC curve analysis. 99m Tc-mebrofenin hepatobiliary scintigraphy demonstrated better sensitivity, specificity, and positive and negative predictive value compared to future remnant liver volume. Using 99m Tc-mebrofenin hepatobiliary scintigraphy, one cutoff value suffices in both compromised and noncompromised patients. Conclusion Preoperative 99m Tc-mebrofenin hepatobiliary scintigraphy is a valuable technique to estimate the risk of postoperative liver failure. Especially in patients with uncertain quality of the liver parenchyma, 99m Tc-mebrofenin HBS proved of more value than CT volumetry.