Hepatobiliary function assessed by 99mTc-mebrofenin cholescintigraphy in the evaluation of fibrosis in chronic hepatitis: histopathological correlation

Abstract

Although liver biopsy remains the gold standard in the staging of liver fibrosis in chronic hepatitis C virus (HCV) infection, several noninvasive methods are under evaluation for clinical use. The aim of this study was to evaluate the utility of hepatobiliary function through technetium-99m-N-(-3-bromo-2,4,6-trimethylacetanilide) iminodiacetic acid (Tc-mebrofenin) scintigraphy in evaluating liver fibrosis in patients with chronic HCV infection. We studied 62 patients with HCV (18 men, 44 women). The patients were allocated into three groups according to histopathological score: group 1: portal/periportal fibrosis (21 patients; eight men, 13 women); group 2: bridging fibrosis (23 patients; seven men, 16 women); and group 3: incomplete/complete cirrhosis (18 patients; three men, 15 women). As a control group, 20 healthy volunteers (six men and 14 women) were studied. Hepatocyte mebrofenin uptake rate, the time required for maximal hepatic activity (Tmax), and the time required for peak activity to decrease by 50% (T1/2max) were calculated using Tc-mebrofenin cholescintigraphy. Scintigraphic parameters were correlated with biochemical parameters and liver histopathology. The uptake rates were significantly decreased in all groups with fibrosis compared with the controls (P<0.05). The correlation between the severity of fibrosis and Tc-mebrofenin uptake rate was strongly significant (r=-0.81, P<0.0001). Tmax and T1/2max were significantly prolonged in groups 2 and 3 compared with the controls. Histopathology score was correlated moderately with Tmax and T1/2max (r=0.61, P<0.0001 and r=0.52, P<0.0001, respectively). The assessment of hepatobiliary function by Tc-mebrofenin scintigraphy may be a good choice for assessing the severity of liver fibrosis in patients with HCV.