Evaluating Liver Functional Reserve By Combining Quantitative Assessment Of Hepatic Fibrosis With Indocyanine Green Measurement

Background:Cirrhosis is the final result of chronic damage to the liver from various etiologies, characterized by parenchymal injury leading to extensive fibrosis and nodular regeneration. The result is a diffuse disorganization of hepatic morphology with progressive loss of liver function. Cirrhosis is most commonly the result of hepatitis B and C virus infection or chronic alcoholism; other causes are biliary, cryptogenic and metabolic. Usual clinical manifestations result from portal hypertension, portosystemic shunting and hepatic insufficiency. Common complications are ascites gastrointestinal bleeding, encephalopathy and coagulopathy.Liver resection is the only treatment with the potential to cure a patient of hepatocellular carcinoma. Despite progress in operative procedures and peri-operative care, the possibility or extent of liver resection is still limited in many cases by liver dysfunction [1]. In additional, patients with biliary tract cancer or meta-static liver tumors who require extensive liver resection also run a high risk of postoperative liver failure, even if the liver function is normal [2, 3]. The outcome of liver resection is therefore affected by hepatic functional reserves and remnant liver volume as well as the surgical procedure and perioperative care [4, 5]. Although various preoperative assessments have been reported [6,7], they alone are not enough to predict postoperative liver failure.Objective:To investigate the value of quantitative assessment of hepatic fibrosis and indocyanine green measurement in predicting hepatic functional reserve in rats with liver cirrhosis. Then we try to find how Differences of retention rate of indocyanine green at fifteen minute (ICGR₁₅) and quantitative assessment of hepatic fibrosis by using computer-assisted digital image with Child-Pugh.Methods:50 Female Wister rats(specific-pathogen free) were divided into three groups(normal control group and 8 weeks group and 10 weeks group models), then cirrhotic models were established. Observe general state of health of Wister rats and calculate Child-Pugh score in rats with liver cirrhosis. Quantitative assessment of hepatic fibrosis, by using computer-assisted digital image analysis, and ICGR₁₅ were measured, correlation among Child-Pugh and ICGR₁₅ and the percentage of fibrosis was analysis.Results:Blood biochemistry between normal control groups and models group was statistically significant (P<0.01).Differences of ICGR₁₅ and quantitative assessment of hepatic fibrosis among the three groups (control group, 8 weeks group and 10 weeks group) were statistically significant (P<0.01). The positive linear correlation(r=0. 645) was found between Child-Pugh and R₁₅ICG in the rats with liver cirrhosis .The positive linear correlation(r=0. 0.533) was found between Child-Pugh and the values of the percentage of hepatic fibrosis in the rats with liver cirrhosis, and the correlation was significant at the level of 0.05.Conclusion:The ICG excretive test can more objectively reflect the hepatic functional reserve. Computer-assisted digital image ananlysis represents an objective method for assessing hepatic fibrosis. Combining quantitative assessment of hepatic fibrosis with indocyanine green measurement is helpful for assessment of liver functional reserve. It may be useful in diagnosing hepatic fibrosis, evaluating therapeutic efficacy for hepatic fibrosis and predicting hepatic functional reserve preoperatively.