Assessment of hepatic functional regeneration after hepatectomy using 99m Tc-GSA SPECT/CT fused imaging
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ORIGINAL ARTICLE
Assessment of hepatic functional regeneration after hepatectomy using 99mTc-GSA SPECT/CT fused imaging Morikatsu Yoshida • Shinya Shiraishi • Fumi Sakamoto • Toru Beppu • Daisuke Utsunomiya • Hirohisa Okabe • Seiji Tomiguchi • Hideo Baba • Yasuyuki Yamashita
Received: 21 January 2014 / Accepted: 19 June 2014 / Published online: 8 July 2014 Ó The Japanese Society of Nuclear Medicine 2014
Abstract Background The liver itself regenerates after hepatectomy but little is known about how much hepatic function recovers during the regeneration. The liver uptake value (LUV), calculated from Tc-99m-labeled galactosyl-human-serumalbumin (99mTc-GSA) SPECT/CT fused images, is reliable and useful for evaluating hepatic function. In this study, we evaluated the clinical usefulness of LUV for estimating hepatic functional regeneration after hepatectomy. Methods We enrolled 95 patients who had undergone 99m Tc-GSA SPECT/CT tests before/on days 30 and 90 after hepatectomy. We determined the LUV from the 99mTcGSA SPECT/CT images and calculated the %LUV (postoperative LUV/preoperative LUV 9 100). Based on surgical procedures and histopathological damage, we divided the study population into patients with severe (n = 12) or
M. Yoshida (&) S. Shiraishi F. Sakamoto D. Utsunomiya Y. Yamashita Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Chuo-ku, Honjo, Kumamoto, Japan e-mail: [email protected] T. Beppu H. Okabe H. Baba Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan T. Beppu Department of Multidisciplinary Treatment for Gastroenterological Cancer, Innovation Center for Translational Research, Kumamoto University Hospital, Kumamoto, Japan S. Tomiguchi Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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non-severe fibrosis (n = 33) who had undergone minor hepatectomy, and patients with severe (n = 14) or nonsevere fibrosis (n = 36) having major hepatectomy. On the 90th post-hepatectomy day, five patients manifested liver failure; in these patients, we analyzed the co-relation between liver failure and the results of the liver function tests performed on day 30 after surgery. Results Although the %LUV reached 95.4 ± 12.2 % in 30 days, in patients with severe fibrosis after major hepatectomy it remained below 90 %. Patients having low %LUV (\75 %) and high serum bilirubin ([2.0 mg/dl) at 30 days showed a relative risk of liver failure of 12.0 and 4.5 (p \ 0.001 and p \ 0.001), respectively. Conclusions Although the %LUV recovered to about 95 % in all patients within 30 days after the hepatectomy, in patients with severe fibrosis having major hepatectomy, the process of recovery was delayed. The %LUV corresponded to the quality of the liver function which emerged in a later post-hepatectomy phase. Keywords 99mTc-GSA SPECT Hepatectomy Hepatic functional regeneration
Introduction Liver regeneration is crucial fo
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