Retrospective Study
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World J Gastroenterol. Nov 28, 2014; 20(44): 16714-16720
Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16714
Hepatic clearance measured with 99mTc-GSA single-photon emission computed tomography to estimate liver fibrosis
Masahiko Taniguchi, Atsutaka Okizaki, Kenji Watanabe, Koji Imai, Koichiro Uchida, Takahiro Einama, Noriyuki Shuke, Naoyuki Miyokawa, Hiroyuki Furukawa
Masahiko Taniguchi, Kenji Watanabe, Koji Imai, Koichiro Uchida, Takahiro Einama, Hiroyuki Furukawa, Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical College, Asahikawa 078-8510, Japan
Atsutaka Okizaki, Noriyuki Shuke, Department of Radiology, Asahikawa Medical College, Asahikawa 078-8510, Japan
Naoyuki Miyokawa, Department of Pathology, Asahikawa Medical College, Asahikawa 078-8510, Japan
Author contributions: Taniguchi M designed the study and wrote the manuscript; Okizaki A, Watanabe K, Einama T, Uchida K, Imai K and Miyokawa N collected the data; Taniguchi M and Okizaki A analyzed the data; and Shuke N and Furukawa H revised the manuscript.
Correspondence to: Masahiko Taniguchi, MD, Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical College, 2-1, Midorigaoka-Higashi, Asahikawa 078-8510, Japan. m-tani@asahikawa-med.ac.jp
Telephone: +81-166-682503 Fax: +81-166-682193
Received: February 12, 2014
Revised: June 3, 2014
Accepted: July 22, 2014
Published online: November 28, 2014
Abstract

AIM: To evaluate the clinical utility of hepatic clearance (HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) to estimate the degree of liver fibrosis.

METHODS: Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study. Indocyanine green clearance (ICG R15), quantitative indices estimated by 99mTc-GSA [the receptor index (LHL15 and HH15) and HC via SPECT analysis], and conventional liver function tests were performed before hepatectomy. Correlations among the quantitative indices for liver functional reserve, conventional liver function tests, and the degree of liver fibrosis were evaluated.

RESULTS: The degree of liver fibrosis was correlated with ICG R15, HH15, LHL15, and HC. HC showed the best correlation with conventional liver function tests. According to multivariate analysis, HC and LHL15 were significant independent predictors of severe fibrosis. HC was the most valuable index for predicting severe fibrosis.

CONCLUSION: HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.

Keywords: Fibrosis; Technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin; Single-photon emission computed tomography; Hepatic clearance; Liver resection

Core tip: This retrospective study evaluated the clinical utility of hepatic clearance measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography for estimating the degree of liver fibrosis. We demonstrated that 99mTc-GSA hepatic clearance showed strong correlations with the degree of liver fibrosis and conventional liver function tests. It is a reliable index for assessing severe liver fibrosis. We believe that this quantitative index can yield a more accurate estimation of liver fibrosis compared with currently used measures before hepatectomy for hepatobiliary surgeons.