Utility of Technetium-99m-Labeled-Galactosyl Human Serum Albumin Scintigraphy for Estimating the Hepatic Functional Reserve

Fujioka, Hikaru; Kawashita, Yujo; Kamohara, Yukio; Yamashita, Akihiko; Mizoe, Akihiko; Yamaguchi, Junzo; Azuma, Takashi; Furui, Junichiro; Kanematsu, Takashi

doi:10.1097/00004836-199906000-00009

Cited by 36 publications

(39 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also found that these parameters were well correlated with the Child-Pugh score and with biochemical markers, as well as with the results of previous studies on Tc-99m-GSA scintigraphy (10)(11)(12)25). However, in comparison to SPIO-MRI with scintigraphy, our results showed that Child-Pugh score and prothrombin time are closely correlated with reduction-%LMR on SPIO-MRI rather than HH15 and LHL15 on Tc-99m-GSA scintigraphy.…”

Section: Discussionsupporting

confidence: 88%

“…On the other hand, several methods have been reported for calculating hepatic Tc-99m-GSA uptake in order to ensure maximum clinical efficacy in the evaluation of reserve by Tc-99m-GSA scintigraphy (10)(11)(12). Previous studies reported that Tc-99m-GSA scintigraphy is able to evaluate the decrease in hepatic functional reserve caused by portosystemic shunts more precisely than biochemical markers (31,32).…”

Section: Discussionmentioning

confidence: 99%

“…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). Reserve function is often assessed by scintigraphy, particularly in Japan using technetium-99m-galactosyl human serum albumin (Tc-99m-GSA), a synthetic radioligand that binds to the asialoglycoprotein receptor on the plasma membrane of liver cells (10)(11)(12). Tc-99m-GSA scintigraphy enables more objective evaluation of hepatic functional reserve than the above clinical parameters (13).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Tonan

Fujimoto

Qayyum

et al. 2011

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. Kupffer cells contribute to the pathogenesis of liver injury in chronic liver disease, yet it is difficult to assess Kupffer cell function either ex vivo or in vivo, since supporting data are limited. The aim of this study was to clarify the relation between Kupffer cell function and hepatocyte function by analyzing the correlation between conventional indices of hepatic functional reserve and both superparamagnetic iron oxide-enhanced MRI (SPIO-MRI) and technetium-99m-galactosyl human serum albumin scintigraphy (Tc-99m-GSA) in patients with chronic viral hepatitis. Consecutive 46 patients (16 patients with chronic hepatitis and 30 patients with cirrhosis) who underwent both SPIO-MRI and Tc-99m-GSA were examined. The patients were aged 46-83 years (median 70) and included 29 men and 17 women. Spearman correlation coefficient was used to analyze the correlations between functional reserve indices and both reduction percentages of liver-to-muscle signal intensity ratio (reduction-%LMR), as a surrogate parameter of Kupffer cell function and Tc-99m-GSA parameters. The usefulness of each parameter as a marker to differentiate Child-Pugh A from Child-Pugh B/C was evaluated using receiver operating characteristic (ROC) analysis. The reduction-%LMR correlated more closely with Child-Pugh score (r=0.77; P<0.001) than did Tc-99m-GSA parameters. For predicting Child-Pugh B/C, ROC analysis revealed that reduction-%LMR (AUC=0.91, P<0.001) was the most useful parameter and at a cutoff value of 50% or less, sensitivity, specificity, positive and negative predictive values were 0.79, 0.91, 0.94 and 0.71, respectively. SPIO-MRI may be a helpful non-invasive method for the evaluation of hepatic functional reserve, and this study suggests that Kupffer cell function is closely correlated with hepatocyte function in patients with chronic viral hepatitis. IntroductionProper assessment of hepatic functional reserve is crucial to the selection of patients for hepatic surgery, particularly in liver transplantation and the management of liver cirrhosis. The Child-Pugh score (1,2) is now used worldwide as the standard in the assessment of hepatic functional reserve (3). Given the relation between this score and survival in patients with cirrhosis of the liver, it has recently been listed as one of the parameters in the minimal criteria of the liver transplant Abbreviations: SPIO, superparamagnetic iron oxide; Tc-99m-GSA-scintigraphy, scintigraphy using technetium-99m-labelled galactosyl human serum albumin; GRE, gradient-recalled echo; ROIs, regions of interest; %LMR, percentages of liver-to-muscle signal intensity ratio; H15, uptake ratio of the heart at 15 min after Tc-99m-GSA injection; H3, uptake ratio of the heart at 3 min after Tc-99m-GSA injection; HH15, index of blood clearance = H15/H3; L15, radioactivity of the liver at 15 min after Tc-99m-GSA injection; LHL15, the receptor index = L15/(H15 + L15); ICG15, indocyanine green retention rate at 15 min; ROC analysis, receiver operating characteristic analysisKey words: chro...

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Tonan

Fujimoto

Qayyum

et al. 2011

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

show abstract

“…A discrepancy between the ICG clearance test and 99m Tc-GSA scintigraphy is described in 9%-20% of the patients in whom the histologic severity of disease is better reflected by 99m Tc-GSA scintigraphy (30,31). 99m Tc-GSA scintigraphy is also effective in assessing hepatic function in patients with hyperbilirubinemia (32)(33)(34).…”

Section: M Tc-gsa Scintigraphy Backgroundmentioning

confidence: 99%

“…Specific cutoff values for LHL15 (i.e., 0.90 (48) and 0.875 (31)) have been described to select patients with a high risk for complications. Other cutoff values include LHL15/preoperative liver volume of 0.76 (32) and total asialoglycoprotein receptor concentration in the FRL of 0.05 mmol (31,49). Cutoff values, however, usually are not based on accurate risk analysis but rather are set arbitrarily.…”

Section: Kinetics and Quantitative Measurement Of Liver Functionmentioning

confidence: 99%

Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

Graaf¹,

Bennink²,

Veteläinen³

et al. 2010

J Nucl Med

133

118

View full text Add to dashboard Cite

This review describes the application of 2 nuclear imaging techniques for assessment of hepatic function in the setting of liver surgery and transplantation. The biochemical and technical background, as well as the clinical applications, of 99m Tc-labeled diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) scintigraphy and hepatobiliary scintigraphy (HBS) with 99m Tc-labeled iminodiacetic acid derivates is discussed. 99m Tc-mebrofenin is considered the most suitable iminodiacetic acid agent for 99m Tc-HBS. 99m Tc-GSA scintigraphy and 99m Tcmebrofenin HBS are based on 2 different principles. 99m Tc-GSA scintigraphy is a receptor-mediated technique whereas HBS represents hepatic uptake and excretion function. Both techniques are noninvasive and provide visual and quantitative information on both total and regional liver function. They can be used for preoperative assessment of future remnant liver function, follow-up after preoperative portal vein embolization, and evaluation of postoperative liver regeneration. In liver transplantation, these methods are used to assess graft function and biliary complications.

show abstract

KICG value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation

et al. 2006

View full text Add to dashboard Cite

Reliable monitoring enabling evaluation of graft function is crucial after living-donor liver transplantation (LDLT). A method to identify poor graft function at an early postoperative period would allow opportune intensive clinical management to bring about further improvements in LDLT outcomes. This study assessed the reliability of the indocyanine green (ICG) elimination rate constant (K ICG ) value as an estimator of graft function and determined the actual temporal changes of K ICG after LDLT. K ICG values were measured using a noninvasive method in 30 adult recipients up to 28 days after LDLT. The receptor index (LHL15) based on liver scintigraphy, and graft parenchymal damage score based on histopathological findings were evaluated after LDLT and correlated well with simultaneous K ICG . Thus, K ICG measured by noninvasive method was confirmed as accurately evaluating graft function. Changes of K ICG after LDLT in recipients with good graft function were maintained, after some falls in the early periods, and had a significant difference compared with those for recipients without good graft function; moreover, there were already significant differences in K ICG 24 hours after LDLT. Mean transit time reflecting systemic hemodynamics revealed that recipients without good outcomes fell into an unstable systemic hemodynamic state, and effective hepatic blood flow has a large influence on liver regeneration after LDLT. In conclusion, we suggested that K ICG values can predict clinical outcomes at the early postoperative period after LDLT by sharply reflecting the influence of systemic dynamics on splanchnic circulation. See Editorial on Page 514Liver allografts suffer several types of attacks, such as ischemia reperfusion injury and acute rejection, and they are exposed to risks, including hepatic blood flow disorders. Therefore, a precise estimation of graft function after living donor liver transplantation (LDLT) is extremely important; indeed, it is indispensable for appropriate postoperative treatments. However, conventional simple liver function tests, such as the aspartate aminotransferase (AST), alanine aminotransferase (ALT), and prothrombin time international normalized ratio (PT-INR), can assist in evaluating graft function but are not always conclusive. Though 81 LDLT (51 right-lobe, 21 left-lobe, and 9 lateral-segment grafts) to 73 adult and 8 pediatric recipients have been performed to date in our facilities, we have had concerns regarding the accurate evaluation of graft function. Since indocyanine green (ICG), a nontoxic dye, is extracted exclusively by hepatic parenchymal cells without enterohepatic circulation 1 and excreted entirely into the bile, an ICG clearance test has been used to more precisely assess liver functional reserve before hepatectomy. 2-4 However, actual temporal changes of ICG clearance with regard to LDLT have not been sufficiently investigated. This study had 3 aims. The first aim was to clarify actual changes in ICG clearance after LDLT. Recently, a noninvasive method for...

show abstract

Utility of Technetium-99m-Labeled-Galactosyl Human Serum Albumin Scintigraphy for Estimating the Hepatic Functional Reserve

Cited by 36 publications

References 17 publications

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

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

Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

KICG value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation

Contact Info

Product

Resources

About