Abstract
Background/aimsAlthough volumetric imaging by computed tomography (CT) is the gold standard for preoperative assessment of the future liver remnant, nuclear imaging studies have shown promising data. This systematic review summarized the results from trials investigating volumetric and nuclear medicine imaging for the prediction of postoperative mortality and liver failure (LF).MethodsMEDLINE and Web of Science were searched for papers investigating nuclear imaging methods for the prediction of postoperative clinical outcomes in patients undergoing local, liver-directed treatments. Only papers investigating both preoperative nuclear imaging and CT or magnetic resonance imaging (MR) for the prediction of postoperative mortality and/or LF were included.ResultsTwenty-five trials were qualified for this review. All trials but two used technetium-based tracers for the nuclear imaging examination. Four papers used MR imaging and the remaining used CT for the volumetric evaluation. Overall, the studies were heterogeneous both in terms of methodology and imaging technique. Of the thirteen studies reporting on postoperative mortality, most were descriptive without detailed diagnostic data. A few with detailed data found that nuclear imaging had better predictive value than volumetric imaging. Nineteen studies investigated the prediction of postoperative LF of which seven papers investigated the predictive value of both modalities in multivariable regression analysis. Two papers found that only nuclear imaging parameters were predictive of LF, one paper found that the CT parameter was predictive, and four papers found that combined nuclear and CT/MR imaging parameters were predictive of LF.ConclusionBoth methodologies were useful in the preoperative assessment of patients scheduled for liver interventions, especially in combination, but nuclear imaging demonstrated better predictive value for postoperative mortality and LF in a few trials. The overall technical and methodological heterogeneity of the included studies complicates the ability to directly compare the clinical utility of the two imaging techniques.
Highlights
The volume of the future liver remnant (FLR) assessed by computed tomography (CT) is broadly considered the gold standard for preoperative liver assessment both in terms of determining eligibility for surgery and the extent of surgery [1]
For this sub-study of the original systematic review, we identified original studies where patients underwent a functional nuclear imaging-based examination as well as an anatomical examination by CT or magnetic resonance (MR) imaging prior to localized, liver-directed treatments with the purpose of removing impaired liver tissue
We sought to investigate whether preprocedural nuclear imaging was significantly better than CT/MR imaging for the prediction of postprocedural mortality and liver failure (LF)
Summary
The volume of the future liver remnant (FLR) assessed by computed tomography (CT) is broadly considered the gold standard for preoperative liver assessment both in terms of determining eligibility for surgery and the extent of surgery [1]. In patients with underlying parenchymal liver disease, the functional capacity of the liver is not necessarily homogenously distributed. If the liver morphology and function are considered normal, 75–80% of the total liver volume can be safely resected [2–8]. One cutoff level for a safe liver resection might suffice irrespective of the underlying liver condition [9, 10]. Based on a previously published systematic review from the same literature search, preoperative nuclear imaging has been shown to predict postoperative liver failure (LF) in several studies [11]. The purpose of this systematic review was to summarize the studies investigating both preoperative functional imaging with nuclear medicine and volumetric imaging with CT or magnetic resonance (MR) imaging for the prediction of postoperative mortality and/or liver failure (LF) in patients undergoing local liver-directed treatments
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