Preoperative assessment of residual hepatic functional reserve using Tc-99m-DTPA-galactosyl-human serum albumin dynamic SPECT

Preoperative assessment of residual hepatic functional reserve offers impor tant strategic information for hepatic resection. To predict the postoperat ive residual liver function, we assessed the value of hepatic Tc-99m-diethy lenetriamine pentaacetic acid-galactosyl-human serum albumin (Tc-99m-GSA) c learance estimated by dynamic SPECT analysis. Methods: We investigated 114 consecutive patients with liver disease, including 55 hepatectomy cases. On e minute after injection of 185 MBq Tc-99m-GSA, 15 serial dynamic SPECT ima ges were obtained every minute. The initial five sets of SPECT images were analyzed by Patlak plot to estimate the sequential initial hepatic Tc-99m-G SA clearance (mL/min) as an index of hepatic function. The sum of hepatic T c-99m-GSA clearance of the segments immune from resection was categorized a s predicted residual Tc-99m-GSA clearance. In the hepatectomy cases, scinti graphy was performed before and 37 +/- 10 d after the operation, Results: G ood correlation was observed between the total hepatic Tc-99m-GSA clearance and conventional hepatic function tests: plasma retention rate of iodocyan ine green (ICG) at 15 min (ICG R15), r = -0.600, P < 0.0001, n = 94; plasma disappearance rate of ICG (K ICG), r = 0.670, P < 0.0001, n = 83; cholines terase, r = 0.539, P < 0.0001, n = 121; serum albumin, r = 0.421, P = 0.000 1, n = 123; and hepaplastin test, r = 0.456, P < 0.0001, n = 120. There was good correlation between the predicted residual Tc-99m-GSA clearance and t he postoperative total hepatic Tc-99m-GSA clearance in patients who underwe nt segmentectomy or lobectomy (r = 0.84, P < 0.0001, n = 28) and between th e pre- and postoperative total hepatic Tc-99m-GSA clearance in patients who underwent subsegmentectomy (r = 0.91, P < 0.0001, n = 25). Five patients w ho had postoperative complications due to hepatic insufficiency (2 patients died of postoperative hepatic failure within 2 mo after operation) showed significantly lower predicted residual Tc-99m-GSA clearance compared with t he patients without complications (90.3 +/- 37.2 versus 320.9 +/- 58.8 mL/m in; P < 0.005). Conclusion: The total hepatic Tc-99m-GSA clearance reflecte d hepatic function. In addition, preoperative predicted residual hepatic Tc -99m-GSA clearance was a good indicator of postoperative hepatic function a nd early prognosis. Tc-99m-GSA dynamic SPECT is assumed to be a useful meth od for determining the surgical strategy in patients with hepatic tumor and especially in patients with hepatic dysfunction.