Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection

Abstract

Background: (99m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) was used as a quantitative method to evaluate liver function. The aim of this study was to compare future remnant liver function assessed by (99m)Tc-mebrofenin hepatobiliary scintigraphy with future remnant liver volume in the prediction of liver failure after major liver resection.

Methods: Computed tomography (CT) volumetry and (99m)Tc-mebrofenin hepatobiliary scintigraphy were performed prior to major resection in 55 high-risk patients, including 30 patients with parenchymal liver disease. Liver volume was expressed as percentage of total liver volume or as standardized future remnant liver volume. Receiver operating characteristic (ROC) curve analysis was performed to identify a cutoff value for future remnant liver function in predicting postoperative liver failure.

Results: Postoperative liver failure occurred in nine patients. A liver function cutoff value of 2.69%/min/m(2) was calculated by ROC curve analysis. (99m)Tc-mebrofenin hepatobiliary scintigraphy demonstrated better sensitivity, specificity, and positive and negative predictive value compared to future remnant liver volume. Using 99mTc-mebrofenin hepatobiliary scintigraphy, one cutoff value suffices in both compromised and noncompromised patients.

Conclusion: Preoperative (99m)Tc-mebrofenin hepatobiliary scintigraphy is a valuable technique to estimate the risk of postoperative liver failure. Especially in patients with uncertain quality of the liver parenchyma, (99m)Tc-mebrofenin HBS proved of more value than CT volumetry.

Figures

Figure 1

An example is shown of summed HBS images from 150–300 s after i.v. injection of 99mTc-mebrofenin (a). A ROI is drawn around the entire liver (red line) and around the mediastinum (blood pool; yellow line). A third ROI is drawn around the future remnant liver (green line). A blood pool corrected liver-uptake time–activity curve is shown in b. The hepatic 99mTc-mebrofenin uptake is calculated as an increase of 99mTc-mebrofenin uptake (y-axis) per minute over a time period of 200 s (x-axis). c The use of the anterior projection of the liver on the CT volumetry image as a guideline for delineating the FRL on the HBS image (d).

Figure 2

Total hepatic 99mTc-mebrofenin uptake according to parenchymal status. Patients with parenchymal liver disease had significantly less liver (uptake) function (gray box, 7.4 ± 1.4%/min/m2) as compared to patients with healthy liver parenchyma (white box, 8.5 ± 1.7%/min/m2, P = 0.007; a). Total liver volume: (NTTL-V) was significantly higher in patients with compromised livers (1,037.1 ± 208.0 vs. 877.0 ± 143.3 mL/m2, P = 0.001; b).

Figure 3

Scatter plot showing the correlation between preoperative FRL-F and actual postoperative remnant liver function measured within 3 days after surgery (33 patients, Pearson r = 0.81, P < 0.0001).

Figure 4

Scatter plot showing the correlation between FRL-F and FRL-V. In patients with normal livers (black line), FRL-V correlated well with FRL-F (Pearson r = 0.71, P = 0.0001). Patients with compromised livers (gray line) showed a moderate correlation between FRL volume and FRL function (Pearson r = 0.61, P < 0.0003).

Figure 5

Receiver operator characteristic curve analysis of FRL-F in the prediction of liver failure. A cutoff value for FRL-F of 2.69%/min/ m2 identified patients with a significant risk of developing postoperative liver failure (area under the curve = 0.916; 95% confidence interval 0.837–0.994).