PREOPERATIVE EVALUATION OF HEPATIC FUNCTIONAL RESERVE FOLLOWING HEPATECTOMY BY TC-99M GALACTOSYL HUMAN SERUM-ALBUMIN LIVER SCINTIGRAPHY ANDCOMPUTED-TOMOGRAPHY

It is extremely important to have a good grasp of the acceptable limit of hepatectomy before operation because postoperative liver failure c an take a fatal course; however, baseline data on the limit of hepatec tomy have not been clearly defined. We therefore evaluated and compare d the predicted remnant liver function obtained by computed tomography (CT) and technetium-99m diethylenetriamine penta-acetic acid-galactosy l human serum albumin (Tc-99m-GSA) liver scintigraphy in order to obta in precise data regarding remnant liver function before hepatectomy. W e investigated 20 patients undergoing hepatectomy using the clearance rate of indocyanine green (KICG) as a parameter, and compared the pred icted postoperative KICG obtained by CT and by transaxial single-photo n emission tomographic (SPET) images acquired by Tc-99m GSA liver scin tigraphy before hepatectomy. In GSA studies, based on time-activity cu rves for the heart and liver, we compared HH15 (heart activity at 15 m in divided by heart activity at 3 min), LHL15 (liver activcity at 15 m in divided by heart plus liver activity at 15 min) and K-L (obtained f rom the time-activity curve for the liver) in 103 patients. In 58 pati ents without increased serum bilirubin, K-L 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 vo lume were compared between CT and Tc-99m GSA liver scintigraphy. The c orrelation coefficient between the postoperative KICG predicted by CT and the actual postoperative KICG was rather pool, at r = 0.569 (P<0.0 5); that between the postoperative KICG predicted by Tc-99m GSA liver scintigraphy and the actual postoperative KICG was good, at r = 0.788 (P<0.01); correlations between K-L and HH15 and between K-L 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 K-L and KICG in 58 pa tients was very good, at r = 0.916 (P<0.001). In all four cases of rig ht portal vein occlusion, the remnant liver volume ratio was markedly increased after occlusion in GSA compared with CT, and the postoperati ve KICG predicted by GSA after occlusion was closer to the actual post operative KICG than that predicted by CT. It is concluded that Tc-99m GSA liver scintigraphy is useful for predicting remnant liver function before hepatectomy and for evaluating changes in regional liver funct ion after occlusion of the portal vein unilaterally.