Response to percutaneous transhepatic portal embolization: New proposed parameters by Tc-99m-GSA SPECT and their usefulness in prognostic estimation after hepatectomy

Accumulation of Tc-99m-galactosyl human serum albumin (GSA) in the liver co rrelates well with the parameters of hepatic function tests. We performed T c-99m-GSA SPECT before and after percutaneous transhepatic portal embolizat ion (PTPE) to induce compensatory hypertrophy of the remnant lobe before ex tensive hepatic resection and analyzed the responses of new proposed parame ters in the future remnant lobe that showed hypertrophy. The aim of this st udy was to evaluate the usefulness of these parameters in prognostic estima tion after hepatectomy Methods: We studied 10 patients with cholangiocarcin oma and 1 patient with metastatic liver tumor from sigmoid colon cancer. 99 mTc-GSA SPECT was performed immediately before and 2 wk after PTPE. We anal yzed the responses of the liver uptake ratio (LUR), functional volume (FV), and liver uptake density (LUD) in the future remnant robe and evaluated th eir relationship with the prognosis after subsequent hepatic resection. Res ults: LUR and FV increased slightly but were not associated with the progno sis after hepatic resection, LUD increased significantly after PTPE in the group showing a good outcome after hepatic resection but decreased after PT PE in the group showing a poor outcome (post-PTPE LUD, 0.064 +/- 0.017%/cm( 3) versus 0.035 +/- 0.006%/cm(3), P < 0.05; response rate, 22.2% +/- 11.9% versus -8.9% +/- 17.6%, P < 0,01), Conclusion: Responses of LUD to PTPE bef ore hepatic resection in the future remnant robe represent changes in asial oglycoprotein receptor activity per hepatocyte and predict responses to sub sequent hepatic resection. LUD may be an important parameter for determinin g the outcome after hepatic resection.