Comparison of CT and hepatobiliary scintigraphy in volumetry of future liver remnant after portal vein embolization and RALPPS

Abstract

Background: The study was aimed to compare accuracy of CT and hepatobiliary scintigraphy (HBS) in volumetric estimation of future liver remnant (FLR) before and after portal vein embolization (PVE) and Radiofrequency Assisted Liver Partition with Portal vein embolization in Staged liver resection (RALPPS). Methods: During three years (January, 2015-December, 2017) 46 patients with different malignancies of liver and bile ducts included in the study: PVE (29) and RALLPS (17) were performed when major liver resection was indicated in patients with small FLR. Results: After PVE alone the mean rate of FLR hypertrophy estimated by HBS was significantly larger than the mean rate estimated by CT-volumetry: 71(20-171)% and 31(10-97)%, respectively (p=0,001). After RALPPS the mean rate of FLR hypertrophy estimated by HBS was also significantly larger than the mean rate estimated by CT-volumetry: 86(25-264)% and 45 (0-113)%, respectively (p=0,027). There was no significant differences in the rate of FLR hypertrophy between PVE and RALPPS, estimated by CT (p=0,099) and HBS (p=0,471). Conclusion: HBS is more effective and more precise method of FLR volumetry in comparison with CT-volumetry as HBS considers volumetry of functioning liver parenchyma. In terms of FLR hypertrophy RALPPS did not show evident advantage over PVE, nevertheless, there was a tendency to more effectiveness of RALPPS.