Preoperative remnant liver functional assessment in major hepatectomy after portal vein embolization using 99MTC-GSA scintigraphy /3D-CT fused imaging

Abstract

Objective: The objective of this study was to elucidate the utility of Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy/3D-CT fusion imaging for remnant liver function assessment in major hepatectomy after portal vein embolization (PVE). Methods: From 2012 to September 2016, eleven patients who underwent major hepatectomy for various indications after right PVE were retrospectively analyzed. 3D-CT volumetry and 99mTc-GSA were performed before and after PVE. Indocyanine green plasma clearance rate (KICG) value was also examined and remnant % volume KICG (rem%V = KICG × 3D-CT volumetric rate) and remnant functional % KICG (rem%F = KICG × GSA/3D-CT fused imaging functional rate) were calculated. Optimal hepatectomy was performed when rem%F ≤ §0.05. Furthermore, postoperative liver function, morbidity and mortality were investigated. Results: The rem%V increased from 33.4 to 46.5, and the increment was 29.1%. The rem%F was also increased from 30.6 to 45.5, and the increment was 49.7%. The increment was 20.6% higher in the rem%F compared with rem%V (P < 0.01). Two cases of right trisectionectomy and 8 cases of right hepatectomy were performed according to rem%F criteria. In a case, right hepatectomy was abandoned due to the rem%F was under 0.05 after PVE, bisegmentectomy (S7-8) was undergone based on the criteria. Duration of postoperative hospitalization was 12.5 (7–96) days. One case has failed in Clavien–Dindo grade IIIb, and another one case has failed in grade A posthepatectomy liver failure. There was no peri-operative mortality. Conclusion: 99mTc-GSA/3D-CT fused imaging can estimate accurate future remnant liver function and suitability for major hepatectomy after PVE.