Abstract
IntroductionQuantitative assessment is an essential tool in determining the proportion of liver to be reserved before lobectomy. Technetium-99 m sulfur colloid single-photon emission computed tomography (Tc-99 m SC SPECT-CT) can help in the quantitative assessment of functioning liver tissues and percentage of liver reserve before segmentectomy and lobectomy Matesan et al. (2017), Bowen et al. (2016) and Lam et al. (2013). Presentation of caseA 64-year-old man with alcoholic cirrhosis was admitted to our hospital with a 15 × 10 x 13 cm bilobar HCC. Y90 radioembolization was utilized to downstage the liver tumor. On follow-up CT scan of the liver after radiotherapy, the HCC was much reduced to 6.5 cm in size but still viable with elevated alpha fetoprotein ([AFP] from 225 to 381 to 959 ng/mL). Resection was considered. Constitutional indocyanine green retention at 15 min (ICG-R-15) was 22%. We introduced the Tc-99 m SC SPECT-CT scan in order to assess the percentage liver function of each lobe. It showed minimal uptake in the remaining functioning right lobe with a hypertrophic left lobe to whole liver uptake ratio of 87.1%. This finding gave us confidence to perform right hepatectomy. DiscussionWe used Tc-99 m SC SPECT-CT to estimate the normal functional liver reserve after Y90 radioembolization of a hepatocellular carcinoma (HCC). To our understanding, it is the first case report using Tc-99 m SC to predict the percentage of functional liver reserve after yttrium-90 (Y90) radioembolization. ConclusionTc-99 m SC SPECT-CT is a novel helper used to assess the differential liver function after Y90 radioembolization of HCC and before segmentectomy and lobectomy of the liver.
Highlights
Quantitative assessment is an essential tool in determining the proportion of liver to be reserved before lobectomy
Yttrium-90 (Y90) radioembolization is an effective treatment for unresectable hepatocellular carcinoma (HCC) that has shown feasibility as a tool for downstaging patients for resection [4,5,6,7,8]
Liver function tests remained within the normal range (Table 1); indocyanine green (ICG) was 20% after recheck
Summary
Quantitative assessment is an essential tool in determining the proportion of liver to be reserved before lobectomy. DISCUSSION: We used Tc-99 m SC SPECT-CT to estimate the normal functional liver reserve after Y90 radioembolization of a hepatocellular carcinoma (HCC) To our understanding, it is the first case report using Tc-99 m SC to predict the percentage of functional liver reserve after yttrium-90 (Y90) radioembolization. Correlates with liver function in patients with HCC [1,2] We utilized this agent to assess normal functional liver reserve post-Y90 radioembolization and prior to surgery in a case where neither the patient nor the surgeon would have considered surgery as a feasible treatment option.
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