Using Dynamic 99mT c-GSA SPECT/CT fusion images for hepatectomy planning and postoperative liver failure prediction.

Abstract

BACKGROUND:

Available tools in liver surgery planning rely on the future remnant liver (FRL) volume. Inappropriate decision might be made since the same FRL volume might represent different liver functions depending on the severity of underlying liver damage. This study developed an alternative system to estimate FRL function and to predict the risk of postoperative liver failure.

METHODS:

Current study recruited 71 prehepatectomy patients and 71 healthy volunteers. A technetium-99-labelled asialoglycoproteins was given to participants and SPECT was used to capture the intensity of the signal, represented by uptake index (UI). The agreement between preoperative UI values, liver function tests, and Child scores were evaluated. Linear regression was used to evaluate the agreement between predicted UI for FRL and postoperative UI values. Area under the receiver operating characteristic (AUC) curve was used to evaluate the discriminative performance of UI in differentiating patient with high risk of liver failure.

RESULTS:

Preoperative UIs are highly correlated with Child score (P < 0.0001), especially to identify patients with ascites and elevated bilirubin. The predicted UIs were in close agreement with the actual postoperative UI values (r = 0.95 P < 0.001). The AUC analysis indicated that UI values had a high accuracy in predicting the risk of liver failure (AUC = 0.95, P < 0.0001). The best cut-off point was 0.9 and the corresponding sensitivity was 100 % and specificity was 92 %.

CONCLUSIONS:

The new methodology reliably estimates FRL function and predicts the risk of liver failure. It provides a visual aid for liver surgeon in surgery planning and risk assessment.

• Authors: Yilei Mao, Shunda Du, Jiantao Ba, Fang Li, Huayu Yang, Xin Lu, Xinting Sang, Shaohua Li, Lu Che, Junxiang Tong, Yiyao Xu, Haifeng Xu, Haitao Zhao, Tianyi Chi, Fang Liu, Yanrong Du, Xianzhong Zhang, Xuebin Wang, Jiahong Dong, Shouxian Zhong, Jiefu Huang, Yongming Yu, Jiping Wang
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Issue 4 Pg. 1301-7 (Apr 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 25294018 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Radiopharmaceuticals
• Technetium Tc 99m Aggregated Albumin
• technetium Tc 99m DTPA-galactosyl-human serum albumin
• Technetium Tc 99m Pentetate

Topics

• Adult
• Aged
• Case-Control Studies
• Female
• Follow-Up Studies
• Healthy Volunteers
• Hepatectomy
• Humans
• Liver (diagnostic imaging, pathology)
• Liver Failure (diagnostic imaging, pathology)
• Liver Function Tests (methods)
• Liver Neoplasms (diagnostic imaging, pathology, surgery)
• Male
• Middle Aged
• Neoplasm Staging
• Postoperative Period
• Prognosis
• ROC Curve
• Radiopharmaceuticals (pharmacokinetics)
• Technetium Tc 99m Aggregated Albumin (pharmacokinetics)
• Technetium Tc 99m Pentetate (pharmacokinetics)
• Tissue Distribution
• Tomography, Emission-Computed, Single-Photon
• Tomography, X-Ray Computed
• Young Adult