PREOPERATIVE DETERMINATION OF THE SURGICAL-PROCEDURE FOR HEPATECTOMY USING TECHNETIUM-99M-GALACTOSYL HUMAN SERUM-ALBUMIN (TC-99M-GSA) LIVERSCINTIGRAPHY

Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human ser um albumin (Tc-GSA) is a new liver scintigraphy agent which binds to t he asialoglycoprotein receptors. We evaluated the preoperative assessm ent for hepatectomy using Tc-GSA liver scintigraphy, Ninety patients w ith hepatocellular carcinoma were admitted for elective hepatectomy. T c-GSA scintigraphy was conducted after the intravenous injection of Tc -GSA, and maximal removal rate of Tc-GSA (GSA-Rmax) was calculated usi ng a radiopharmacokinetic model. Measurement of GSA-Rmax, conventional liver function, and 15-minute retention rate of indocyanine green (IC GR15) was carried out preoperatively, The relationships between liver functions, histological activity index (HAI), ICGR15, and GSA-Rmax val ues were estimated, A significant correlation was obtained between GSA -Rrrmax and ICGR15 (r = .534, P < .0001), Preoperative discrepancies b etween GSA-Rmax and ICGR15 values were seen in 15 patients, In these c ases, the GSA-Rmax values correlated well with the total HAI scores (r = .595, P < .02), but no significant correlation was seen between the ICGR15 and HAI scores, Two patients died of postoperative Liver failu re within 2 months of the operation, These two patients were found to have severe discrepancies between their preoperative GSA-Rmax and ICGR 15 values. me concluded that GSA-Rmax might be useful for selecting ca ndidates for hepatectomy and that extended hepatectomies (di- and tri- segmentectomy) are high-risk surgical procedures in the case of low GS A-Rmax scores (below 0.35).