Use of technetium 99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin liver scintigraphy in the evaluation of preoperative and postoperative hepatic functional reserve for hepatectomy
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Abstract
Technetium 99m diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (99mTc-GSA)
is a new liver scintigraphy agent that binds to the asialoglycoprotein receptors.
We evaluated the clinical use of 99mTc-GSA for the perioperative assessment of hepatectomy.
Thirty-six patients with hepatocellular carcinoma were admitted for elective hepatectomy.
99mTc-GSA scintigraphy was obtained after the intravenous injection of 99mTc-GSA,
and a modified receptor index (MRI) was calculated. 99mTc-GSA scintigraphy, conventional
liver function, the plasma disappearance rate, and the 15-minute retention rate of
indocyanine green (ICGR15) were carried out before operation and every 1 to 3 months
after operation. The relationships between several systemic hemodynamic parameters,
histologic activity index (HAI), plasma disappearance rate, and ICGR15 or MRI values
were estimated.
A significant correlation was obtained between the MRI and ICGR15 (r = 0.6231, p <
0.001). Plasma disappearance rates correlated well with systolic volume and left cardiac
work, whereas MRI values did not correlate with these systemic hemodynamics. Preoperative
discrepancies between the values of MRI and ICGR15 were seen in eight cases. In these
cases the MRI values correlated well with HAI scores (p < 0.05) but there was no significant
correlation between ICGR15 values and the HAI scores.
These results suggested the use of 99mTc-GSA scintigraphy as a easy and reliable method
for determining liver functional reserve.