Liver Functional Volumetry by Tc-99m Mebrofenin Hepatobiliary Scintigraphy before Major Liver Resection: A Game Changer

Manoj Gupta, Partha Sarathi Choudhury, Shivendra Singh, Dibyamohan Hazarika, Manoj Gupta, Partha Sarathi Choudhury, Shivendra Singh, Dibyamohan Hazarika

Abstract

Future remnant liver function (FRL-F) estimation is important before major liver resection to avoid posthepatectomy liver failure (PHLF). Conventionally, it is estimated by global dynamic liver function tests which assume homogeneous liver function and unable to calculate regional function. Computed tomography is another method to estimate FRL volume but assumes that volume is equivalent to function. Hence, a global and regional non-invasive liver function test is desirable. Studies were identified by MEDLINE, PubMed, and Google Scholar for articles from January 1990 to December 2017 using the following keywords "Mebrofenin, hepatobiliary scintigraphy (HBS), FRL-F, PHLF, portal vein embolization (PVE)." HBS with technetium-99 m galactosyl human serum albumin (Tc-99m GSA) and Tc-99m Mebrofenin is a known test for functional liver assessment. Restricted availability of Tc-99m GSA only in Japan is a main drawback for its global acceptance. However, Tc-99m Mebrofenin is routinely available to the rest of the world. A unique protocol for FRL-F estimation by Tc-99m Mebrofenin is described in detail in this review. Tc-99m Mebrofenin HBS has shown a strong correlation to 15 min indocyanine green clearance. HBS has been reported better in predicting the risk of PHLF with a 2.69%/min/m2 cutoff of FRL-F. Tc-99m Mebrofenin HBS has been found better in stratification of PVE before major liver surgery as well. We concluded, Tc-99m Mebrofenin HBS was unique in calculating global and regional liver function and takes nonuniformity and underlying pathology in the account. Moreover, a single cutoff might fit in all for PHLF risk assessment and PVE stratification.

Keywords: Future remnant liver function; gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid magnetic resonance imaging; hepatobiliary scintigraphy; mebrofenin; portal vein embolization; posthepatectomy liver failure.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Most frequently used clinical tests for estimation of future remnant liver function and prediction of surgical outcome before major liver resection or liver transplantation (MELD: Model for end-stage liver disease, ICG: Indocyanine green, LiMax: Maximum liver function capacity, GSA: Galactosyl human serum albumin, CT: Computed tomography, MRI: Magnetic resonance imaging)
Box 1
Box 1
Tc-99m Mebrofenin scintigraphy protocol for hepatic extraction fraction
Figure 2
Figure 2
(a) Gmean summed image showing the region of interest over liver, heart, remnant liver, and total field of view. (b) Line graph showing time activity curves of region of interest made in (a) image
Box 2
Box 2
Most common parameters generated in Tc-99m Mebrofenin scintigraphy for future remnant liver function calculation
Figure 3
Figure 3
Tc-99m Mebrofenin single photon emission computed tomography-computed tomography functional volumetry. Image (a) showing maximum intensity projection. Image (b-d) showing the volume of interest for liver and remnant in axial, coronal, and sagittal view, respectively. Volume of interest on the right hepatic duct is showing average liver activity now

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