Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Nakamura, Ikuo; Iimuro, Yuji; Hai, Seikan; Kondo, Yuichi; Hatano, Etsuro; Fujimoto, Jiro

doi:10.1159/000484044

Cited by 8 publications

(7 citation statements)

References 44 publications

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“…0.94. ( p < 0.0001) NR NR (NR) NR ( p < 0.0001) Kokudo et al [ 40 ] 6 R 0 -remnant, 0.16 (μmoles) 0.015 vs. 0.024 ( p = 0.011) NR NR (NR) Per 0.01 μmoles increment: HR 0.82 ( p = 0.022) LHL15, NR 0.89 vs. 0.93 ( p = 0.025) NR NR (NR) NR (NS) HH15, NR 0.58 vs. 0.52 (NS) NR NR (NR) NR (NR) R 0 , NR (μmole) 0.14 vs. 0.18 ( p = 0.038) NR NR (NR) NR (NS) [R] 0 , NR (μM) 0.63 vs. 0.70 (NS) NR NR (NR) NR (NR) Mao et al [ 48 ] Uptake index, 0.9 7 NR (NR) Sens 100%, spec 92% NR (NR) NR (NR) Nakamura et al [ 50 ] LHL15, NR 0.875 vs. 0.903 ( p = 0.015) NR NR (NR) OR 1.32 (NS) Remnant LHL15, 0.755 0.739 vs. 0.791 ( p = 0.009) NR NR (NR) OR 0.03 ( p = 0.023) Nakano et al ≠ [ 51 ] GSA-Rmax, 0.60 NR (NS) NR NR (NR) NR (NS) Nanashima et al ≠ [ 54 ] LHL15, 0.875 NR ( p < 0.001) 4 NR NR (NR) NR (NR) Nanashima et al ≠ [ 55 ] LHL15, 0.85 91.1 vs. 93.1 ( p = 0.014) NR NR (NR) For LHL15 < 0.85 vs. ≥ 0.85: OR 1.4 (NS) …”

Section: Resultsmentioning

confidence: 99%

Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

et al. 2020

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Background: Several nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines. The purpose of this systematic review was to summarize the existing knowledge on this topic. Methods: MEDLINE and Web of Science were searched for studies investigating nuclear medicine imaging methods for the prediction of postoperative liver function in patients undergoing localized, liver-directed treatments. The postoperative endpoints were clinical outcome (morbidity and mortality) as well as measures of postoperative liver function, e.g., liver function assessed by biochemical tests or nuclear imaging. Results: A total of 1352 references were identified, of which 82 fulfilled the eligibility criteria and were included in the review. Most studies (n = 63) were retrospective studies. The vast majority of studies assessed [ 99m Tc]Tcgalactosyl serum albumin (GSA) (n = 57) and [ 99m Tc]Tc-mebrofenin (n = 19). Liver resection was entirely or partly major (involved at least three segments) in 78 reports. There were notable variations in the research methodology, e.g., image acquisition, imaging variables, and endpoints. Thirty-seven studies reported on postoperative mortality, of which most reported descriptive data at the patient level. Of the four reports that performed multivariate analyses, two showed significant predictive results of isotope-based preoperative tests. Fifty-two papers presented data on postoperative liver failure. Multivariate predictive analyses were performed in eighteen trials, of which fifteen showed the significant value of nuclear medicine tests. Conclusion: There is sparse evidence supporting the significant value of nuclear medicine imaging methods in predicting postoperative mortality. In contrast, a notable number of trials showed a significant prediction of liver failure in multivariate analyses. The research methodology was heterogeneous and exploratory in most trials. Documentation of nuclear medicine tests in this setting awaits the results of properly designed, prospective trials with the standardization of both the nuclear medicine test and endpoints.

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Section: Resultsmentioning

confidence: 99%

Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

et al. 2020

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“…The usefulness of 99mTc-GSA scintigraphy as an alternative test to the ICG test has been reported in recent years. 24,37 Sumiyoshi et al reported that there is a large discrepancy between ICG-R15 and actual hepatic function in patients with ICG-R15 > 40 and highly deteriorated ICG-R15 and that 99mTc-GSA scintigraphy assesses hepatic function more accurately than the ICG test does. 22 In patients with good hepatic function who have low ICG-R15, the contribution of LHL15 to the prediction of PHLF is small, but as ICG-R15 increases, the impact of LHL15 on PHLF becomes larger.…”

Section: Discussionmentioning

confidence: 99%

99mTc-GSA scintigraphy and modified albumin–bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure

Mii,

Takahara,

Shibasaki

et al. 2024

Preprint

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Background: Posthepatectomy liver failure (PHLF) remains a severe complication after liver resection. This retrospective study investigated the correlation of three hepatic functional tests and whether 99mTc-galactosyl human serum albumin (99mTc-GSA) scintigraphy and modified albumin–bilirubin (ALBI) score are useful for predicting PHLF. Methods: A total of 413 consecutivepatients undergoing hepatectomies between January 2017 and December 2020 at our institution were enrolled in this retrospective cohort study. To evaluate preoperative hepatic functional reserve, modified ALBI grade, indocyanine green clearance (ICG-R15), and 99mTc-GSA scintigraphy (LHL15) were routinely examined before the scheduled hepatectomy. Based on the retrospective chart review, multivariate logistic regression analysis adjusted for confounding factors was performed to confirm that ALBI, ICG-R15, and LHL15 are independent risk factors for PHLF. Results: ICG-R15 and LHL15 were moderately correlated (r = −0.61). However, the correlation with LHL15 weakened when ICG-R15 was about ³20. Weak correlations were observed between LHL15 and ALBI score (r = −0.269) and ALBI score and ICG-R15 (r = 0.339). Of 413 patients, 66 (19%) developed PHLF (grade A: n = 20, grade B: n = 44, grade C: n = 2). Multivariable logistic regression analyses, mALBI grade (P= .014) and ICG-R15 (P < .001) were significant independent risk factors for PHLF. Subgroup analysis showed that ICG-R15 <19, major hepatectomy, and mALBI grade and ICG-R15 ³19, major hepatectomy, and LHL15 were significant independent risk factors for PHLF (P =.036,.020,.043, and.013, respectively). Conclusion: LHL15 and mALBI grade would be complementary to ICG-R15 for predicting PHLF risk.

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“…155 Tc-99m-GSA scintigraphy-derived parameters show good correlation with postoperative outcomes, including PHLF. 56,83,[156][157][158][159][160][161] The fusion images of SPECT and computed tomography (CT) scans can provide a simultaneous assessment of anatomical details and the corresponding functions. 58,[162][163][164][165] Tc-99m-mebrofenin scintigraphy is also used to obtain functional liver imaging to estimate FLR function and the risk of PHLF after major hepatectomy and two-stage procedures.…”

Section: Hepatobiliary Scintigraphymentioning

confidence: 99%

“…Tc‐99m‐GSA is also applicable for patients undergoing portal vein embolization or two‐stage procedures, as liver function in such patients is not uniform across liver segments 155 . Tc‐99m‐GSA scintigraphy‐derived parameters show good correlation with postoperative outcomes, including PHLF 56,83,156–161 . The fusion images of SPECT and computed tomography (CT) scans can provide a simultaneous assessment of anatomical details and the corresponding functions 58,162–165 .…”

Section: Functional Liver Imagingmentioning

confidence: 99%

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

Nishio

Taura

Koyama

et al. 2023

Annals of Gastroent Surgery

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Liver resection is an effective therapeutic option for patients with hepatocellular carcinoma. However, posthepatectomy liver failure (PHLF) remains a major cause of hepatectomy‐related mortality, and the accurate prediction of PHLF based on preoperative assessment of liver functional reserve is a critical issue. The definition of PHLF proposed by the International Study Group for Liver Surgery has gained acceptance as a standard grading criterion. Liver function can be estimated using a variety of parameters, including routine blood biochemical examinations, clinical scoring systems, dynamic liver function tests, liver stiffness and fibrosis markers, and imaging studies. The Child–Pugh score and model for end‐stage liver disease scores are conventionally used for estimating liver decompensation, although the alternatively developed albumin‐bilirubin score shows superior performance for predicting hepatic dysfunction. Indocyanine green clearance, a dynamic liver function test mostly used in Japan and other Asian countries, serves as a quantitative estimation of liver function reserve and helps determine indications for surgical procedures according to the estimated risk of PHLF. In an attempt to improve predictive accuracy, specific evaluation of liver fibrosis and portal hypertension has gained popularity, including liver stiffness measurements using ultrasonography or magnetic resonance elastography, as well as noninvasive fibrosis markers. Imaging modalities, including Tc‐99m‐labeled galactosyl serum albumin scintigraphy and gadolinium‐enhanced magnetic resonance imaging, are used for preoperative evaluation in combination with liver volume. This review aims to provide an overview of the usefulness of current options for the preoperative assessment of liver function in predicting PHLF.

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Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Cited by 8 publications

References 44 publications

Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

99mTc-GSA scintigraphy and modified albumin–bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

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