Evaluation Of Liver Reserve Function With ^99mTc-EHIDA Hepatobiliary Scintigraphy In Rabbit Liver Injury Model

Objective:To investigate the evaluation of ^99mTc-EHIDA hepatobiliary scintigraphy on liver reserve function in rabbit liver injury model,and to provide a new idea for the establishment of a more accurate assessment of liver reserve function,so as to reduce the incidence of postoperative liver failure.Methods:The experiment was divided into two parts.In the first part,24 New Zealand white rabbits were randomly divided into 25%hepatectomy group,50%hepatectomy group,75%hepatectomy group and control group,6rabbits in each group.Four groups of New Zealand white rabbits were scanned by ^99mTc-EHIDA hepatobiliary scintigraphy,and the dynamic images,time-radioactivity counting curve and nuclide functional indexes(T_peak,Ex₁₅,HLI₅,HH₁₅,LHL₁₅)obtained by hepatobiliary scintigraphy were observed,and the best reserve function evaluation indexes were selected.In the second part,72 New Zealand white rabbits were randomly divided into six groups:CCL₄group and control group,ischemia-reperfusion group and control group,biliary obstruction group and control group,with 12 rabbits in each group.Six groups of New Zealand white rabbits were scanned by ^99mTc-EHIDA hepatobiliary scintigraphy,and the dynamic images,time-radioactivity counting curve and nuclide functional indexes obtained by hepatobiliary scintigraphy were observed.ICGR15 were determined by spectrophotometry in six groups of New Zealand white rabbits.Serum and liver samples of each group were taken,and the levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）andγ-glutamine transferase（γ-GGT）were measured by automatic biochemical analyzer.The pathological injury degree of liver tissue was measured by HE staining.To analyze and compare the correlation between HLI₅,LHL₁₅ and ICGR15 with pathological injury scores.The sensitivity of HLI₅,LHL₁₅ and ICGR15 to assess liver reserve function was analyzed and compared according to different degrees of liver pathological injury.Results:Results of the first part:1.hepatobiliary scintigraphy results showed that the excretion rate of imaging agent in the liver of the model group was significantly slower than that of the control group.2.Time-radioactivity counting curve showed that,with the increase of liver resection rate,the rising and falling trend of time-radioactivity counting curve were gradually slowed down.3.HLI₅ in the model group was significantly increased compared with the control group,and presented a gradually increasing trend with the increase of liver resection rate,and the difference was statistically significant（P<0.05）.LHL₁₅5 in the model group was significantly decreased compared with the control group,and presented a gradually decreasing trend with the increase of liver resection rate,with statistically significant differences（P<0.05）.Results of the second part:1.Compared with the control group,the time-radioactivity counting curve increased and decreased slowly in CCL4 group;HLI₅ and ICGR15 increased significantly with statistically significant differences（P<0.05）;LHL₁₅decreased significantly with statistically significant differences（P<0.05）;serum ALT,AST,γ-GGT levels and liver pathological injury scores increased significantly,with statistically significant differences（P<0.05）.Correlation analysis showed that HLI₅ and ICGR15 were positively correlated with pathological injury score,LHL₁₅ was negatively correlated with pathological injury score,and HLI₅（r=0.755,P=0.004）and LHL₁₅（r=-0.823,P=0.001）were more correlated with pathological injury score than ICGR15（r=0.731,P=0.007）.2.Compared with the control group,the time-radioactivity counting curve increased and decreased slowly in ischemia reperfusion group;HLI₅ and ICGR15 increased significantly with statistically significant differences（P<0.05）;LHL₁₅ decreased significantly with statistically significant differences（P<0.05）;serum ALT,AST,γ-GGT levels and liver pathological injury scores increased significantly,with statistically significant differences（P<0.05）.Correlation analysis showed that HLI₅ and ICGR15 were positively correlated with pathological injury score,LHL₁₅ was negatively correlated with pathological injury score,and HLI₅（r=0.865,P<0.001）was more correlated with pathological injury score than LHL₁₅（r=-0.58,P=0.048）and ICGR15（r=0.801,P=0.002）.3.Compared with the control group,the time-radioactivity counting curve increased and decreased slowly in biliary obstruction group;HLI₅ and ICGR15 increased significantly with statistically significant differences（P<0.05）;LHL₁₅ decreased significantly with statistically significant differences（P<0.05）;serum ALT,AST,γ-GGT levels and liver pathological injury scores increased significantly,with statistically significant differences（P<0.05）.Correlation analysis showed that HLI₅ and ICGR15 were positively correlated with pathological injury score,LHL₁₅ was negatively correlated with pathological injury score,HLI₅（r=0.66,P=0.019）was more correlated with pathological injury score than LHL₁₅（r=-0.535,P=0.073）and ICGR15（r=0.59,P=0.043）.4.Comprehensive analysis showed that compared with the control group,HLI₅ and ICGR15 in the liver injury group were significantly increased,and showed a gradually increasing trend with the aggravation of the injury,and the difference was statistically significant（P<0.05）.However,LHL₁₅5 was significantly decreased compared with the control group,and showed a gradually decreasing trend with the aggravation of injury,and the difference was statistically significant（P<0.05）.Correlation analysis showed that the correlation between HLI₅（r=0.812,P<0.001）and pathological injury score was higher than that of LHL₁₅（r=-0.701,P<0.001）and ICGR15（r=0.749,P<0.001）.Conclusion:1.^99mTc-EHIDA hepatobiliary scintigraphy is a reliable method to assess liver reserve function,among which5 min heart liver index and liver receptor index are the most sensitive indicators.2.Compared with ICGR15,^99mTc-EHIDA hepatobiliary scintigraphy may be a better method for assessing hepatic reserve function in liver injury models.