Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist

Table 2 Overview of preoperative tests to estimate adequate remnant liver function Adapted from Sparrelid et al[3]

Test	Agent used	FLR volume	TL function	FLR function	Distribution	FLR function after	Complexity	Validated for PHLF
Volumetry		Yes	No	No	No	–	–	++
Laboratory scores		No	No1	No	No	–	–	+
ICG test	Indocyanine green	No	Yes	No	No	–	+	++
LIMAX	13C-methacetin	No	Yes	No	No	–	+	+
LIMAX+volumetry	13C-methacetin	Yes	Yes	Yes	No	+	++	+
ICG+volumetry	Indocyanine green	Yes	Yes	Yes	No	+	++	++
HBS	99mTc-Mebrofenin	Yes	Yes	Yes	Yes	++	++	++
RLE-MRI	Gadoxetic Acid	Yes	Limited2	Limited2	Yes	+2	+	+
DCE-MRI	Gadoxetic Acid	Yes	Yes	Yes	Yes	++	+++	–

¹Only sensitive in low liver function/cirrhosis.

²Not absolute.

ICG: Indocyanine green; HBS: Hepatobiliary scintigraphy; RLE: Relative liver enhancement; MRI: Magnetic resonance imaging; DCE: Dynamic contrast-enhanced; FLR: Future liver remnant; TL: Total liver; PHLF: Posthepatectomy liver failure; +: Low; ++: Medium; +++: High.