Utility of technetium-99m-labeled-galactosyl human serum albumin scintigraphy for estimating the hepatic functional reserve

Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum al bumin (Tc-GSA) is a receptor binding agent, specific for asialoglycoprotein receptor, that resides exclusively on the plasma membrane of mammalian hep atocytes. The usefulness of Tc-GSA for estimating the hepatic functional re serve was retrospectively evaluated in patients undergoing a hepatic resect ion. Tc-GSA scintigraphy was performed in 35 patients before hepatectomy, a nd the hepatic uptake ratio (LHL15) was calculated. The LHL15 was then comp ared with the findings of conventional liver function tests, the indocyanin e green retention rate in 15 minutes (ICG R15), and histologic activity ind ex (HAI) score. Significant correlations were observed between the LHL15 an d values of ICG R15, prothrombin time activity, serum levels of total bilir ubin, hyaluronic acid, and values of HAI score. Ratios of LHL15 to preopera tive liver volume (LHL-V) correlated well with the regenerative rates of th e residual liver after major hepatectomy. In addition, patients with more t han 0.76 of LHL-V value had no complications in postoperative course, where as those with less than 0.73 had several complications due to hepatic dysfu nction. Tc-GSA scintigraphy thus appears to be a useful diagnostic tool for evaluating functioning mass of the liver and the values of LHL-V seems to be able to demonstrate regenerative activity in the residual liver after he patectomy.