Dynamic SPECT Imaging To Measure Liver Function Reserve Clinical Application And Research

【Objective】1. To study the feasibility of liver functional reserve assessment by the technetium labeled sub-diethy acetanilide ammonia diacetate (technetium-99m labeled sub-diethyl acetanilide ammonia diacetate, 99mTc-EHIDA) for the imaging agent combined with single photon emission computed tomography imaging (single photon emission computed tomography, SPECT) scan and investigate the preliminary criteria.2. To compare SPECT, ICG15, Child-pugh classification and decide which method have more ability to assessment liver functional reserve.【Methods】Between July 2009 and July 2010, a total of 46 HCC patients undergoing hepatic resection were enrolled. Analyze all patients'clinical data, formulate initial criteria and assess which method is more sensitive.1. SPECT radionuclide scanning line was measured before operation 2 days, radiation peak count of the peak of EHIDA density in live, tmie of the peak of EHIDA density in liver (T peak, min),5 minutes heart liver index (HLI5), blood clearance index (HH15), receptor index (LHL15) and the other variables were all calculated, the relations of radiation peak count of the peak of EHIDA density in live, T peak,HLI5, HH15, LHL15 and postoperative liver failure were studied.2. Comparing ICG15, Child-pugh classification HH15 and deciding which method have more sentitive to assessment liver functional reserve. And analyze the specificity and sensitivity. 【Results】1. The mean value of HH15 in liver failure group and the liver function recovered well group was 0.49±0.08 and 0.59±0.09, respectively, there was significant difference between the two groups (P<0.05).2. Setting 0.533 as cut-off of HH15, the occurrence of postoperative hepatic dysfunction rate between HH15≥0.533 patients and HH15 <0.533 patients was significant difference (χ~2=12.03, P = 0.001).3. HH15 was significant difference between Hepatic dysfunction group and liver function recovered well group comparing to ICGR15 and Child-pugh classification (P = 0.004). The sensitivity and the specificity of HH15 predicting the incidence of postoperative hepatic dysfunction was 93.3% and 64.5%, respectively.4. The liver resection Patients were divided into three groups,received resection of no more than 1segment(group A), received resection of >1and≤2 segment(group B), received resection of more than 2 segment(group C), When HH15 <0.533, there were no statistically significant of the incidence of postoperative hepatic dysfunction among the three groups. ( A and B can not be compared. However between group A and group C, or group B and group C, there were all no significant difference,χ~2 = 0.917, P = 1.000,χ~2 = 1.78, P = 0.375, respectively.) When HH15≥0.533, the incidence of postoperative complications was significant difference between group A and group B, or group A and group C (χ~2 = 7.20, P = 0.013;χ~2 = 9.55, P = 0.005), however, there was no significant difference between group B and group C (χ~2 = 0.83, P = 0.603).【Conclusion】1. HH15 is a sensitive indicator to predict the incidence of liver dysfunction .2. Tentatively, 0.533 is the cut-off value of HH15.3. HH15 is more sensitive indicator than ICGR15 and Child-pugh classification to predict postoperative hepatic dysfunction in this study.4. When HH15 <0.533 , 2 or more segments can be resected safety. When HH15≥0.533 , less than or equal to one segment of liver can been resected securely, however more 1 segment resection will cause high surgical risk.