Preoperative evaluation of hepatic functional reserve by converted ICGR15 calculated from ^99mTc‐GSA scintigraphy

Abstract

Conversion models based on data segregated by severity of liver damage were more closely correlated with ICGR15 than conversion models not based on segregated data. By using this converted ICGR15, preoperative estimation of hepatic functional reserve can become more reliable.

Correlation of Kupffer cell function and hepatocyte function in chronic viral hepatitis evaluated with superparamagnetic iron oxide-enhanced magnetic resonance imaging and scintigraphy using technetium-99m-labelled galactosyl human serum albumin

“…A number of blood biochemical tests have been used to clinically evaluate hepatic functional reserve, including the serum albumin test, prothrombin time test, hepaplastin test, galactose-elimination capacity test (5), 14C-aminopyrine breath test (6), as well as testing for serum cholinesterase activity and indocyanine green retention rate at 15 min after administration (ICGR15) (7). Although these clinical parameters are indeed useful for assessing hepatic functional reserve, discrepancies between them and histological findings are common, suggesting in turn that the parameters do not always accurately reflect hepatic functional reserve (8,9).…”

Prediction of Indocyanine Green Retention Rate at 15 Minutes by Correlated Liver Function Parameters before Hepatectomy

“…Regarding clinical application of the converted ICGR15, we have not yet decided to replace the conventional ICG test (=actual ICGR15) with the converted formula at our institute, as a conversion formula from a previous report [9] was different from our present formula. In addition, it is necessary to examine this conversion formula in a larger set of subjects through multi-center analysis before adoption.…”

“…To account for this omission, total bilirubin levels remained as a significant variable in the multiple linear regression analysis. However, such an equation would not be applicable in patients with biliary obstruction because, in many hospitals in Japan, surgical indication in patients with biliary carcinoma is a total bilirubin level of 2 mg/ml [9]; however, the converted ICGR15 could be lower even at 2 mg/dl total bilirubin. Total bilirubin levels were therefore excluded in the present analysis to avoid such an influence of biliary obstruction.…”

“…We have applied the latter formula to plan the extent of hepatic resection, and the estimated liver volume for resection by computed tomography (CT) was compared to the permitted volume [7,8]. Many investigators have also used the ICGR15 as the most reliable test for hepatic functional reserve before hepatectomy [3,9,10], but in cases of obstructive biliary diseases or vascular shunt of hepatic circulation, the results of ICG might be worse than the true functional reserve [11,12]. Furthermore, some patients are allergic to indocyanine.…”

Treatment strategy for successful hepatic resection of icteric liver

“…Recently, novel tests of FLR, such as serum HA level (13 -15), GSA scintigraphy (16), and interleukin levels (17), have been used to evaluate post-surgical complications. Furthermore, the correlation of LHL15 and HH15 to ICGR15 using a linear regression model and the analysis of individual liver segments by dynamic SPECT are easy and convenient methods for predicting hepatic functional reserve by GSA scintigraphy (18)(19)(20)(21). Therefore, our perioperative protocol for HC patients includes : the drugs (e.g.…”