AIM:To investigate the clinical usefulness of a newly developed index,the "index of convexity(IOC)",for evaluating liver functional reserve using technetium99m-diethylenetriaminepentaacetic acid-galactosylhu...AIM:To investigate the clinical usefulness of a newly developed index,the "index of convexity(IOC)",for evaluating liver functional reserve using technetium99m-diethylenetriaminepentaacetic acid-galactosylhuman serum albumin(Tc-GSA scintigraphy).METHODS:In total,349 patients underwent Tc-GSA scintigraphy.Dynamic planner images were obtained,and time activity curves of the liver and heart were generated and analyzed.Our focus was on the convex shape of the liver accumulation curve.We developed a method for evaluating the extent of convexity and calculated an index that we named the IOC.Clearance index and receptor index were also calculated.The correlations between each GSA index with other liver function tests and liver histopathology were evaluated.RESULTS:Among the 3 indices generated by TcGSA,the IOC had the highest correlation with all other liver function tests(indocyanine green R15,albumin,prothrombin time,cholinesterase level,platelet count,and total bilirubin level).IOC can also differentiate between normal liver,chronic hepatitis,and liver cirrhosis with highest F ratio among GSA indices as determined by one-way analysis of variance.Receiver operating characteristic analysis demonstrated high diagnostic performance of IOC in the diagnosis of cirrhosis.CONCLUSION:IOC is a very simple and reliable index for assessing liver functional reserve,which may prove to be useful in combination with the indocyanine green test for preoperative assessment of hepatic resection.展开更多
BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma...BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma(HCC).METHODS We reviewed the medical records of 199 patients who underwent resection of HCC.Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography.Posthepatectomy liver failure(PHLF)was classified according to the International Study Group of Liver Surgery.Complications was classified according to Clavien–Dindo classification.We analyzed by the risk factors for PHLF,morbidity and mortality with multivariate analysis.RESULTS Twenty-seven(30%)patients had major complications and 23(12%)developed PHLF.The incidence of major complications increased with increasing albumin–bilirubin(ALBI)grade.The area under the curve values for hepatic clearance of the remnant liver,liver to heart-plus-liver radioactivity at 15 min(LHL15),and ALBI score predicting PHLF were 0.868,0.629,and 0.655,respectively.The area under the curve for hepatic clearance of the remnant liver,LHL15,and ALBI score predicting major complications were 0.758,0.594,and 0.647,respectively.The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.CONCLUSION The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.展开更多
文摘AIM:To investigate the clinical usefulness of a newly developed index,the "index of convexity(IOC)",for evaluating liver functional reserve using technetium99m-diethylenetriaminepentaacetic acid-galactosylhuman serum albumin(Tc-GSA scintigraphy).METHODS:In total,349 patients underwent Tc-GSA scintigraphy.Dynamic planner images were obtained,and time activity curves of the liver and heart were generated and analyzed.Our focus was on the convex shape of the liver accumulation curve.We developed a method for evaluating the extent of convexity and calculated an index that we named the IOC.Clearance index and receptor index were also calculated.The correlations between each GSA index with other liver function tests and liver histopathology were evaluated.RESULTS:Among the 3 indices generated by TcGSA,the IOC had the highest correlation with all other liver function tests(indocyanine green R15,albumin,prothrombin time,cholinesterase level,platelet count,and total bilirubin level).IOC can also differentiate between normal liver,chronic hepatitis,and liver cirrhosis with highest F ratio among GSA indices as determined by one-way analysis of variance.Receiver operating characteristic analysis demonstrated high diagnostic performance of IOC in the diagnosis of cirrhosis.CONCLUSION:IOC is a very simple and reliable index for assessing liver functional reserve,which may prove to be useful in combination with the indocyanine green test for preoperative assessment of hepatic resection.
基金The study was reviewed and approved by the Institutional Review Board of Jichi Medical University,Approval No.A21-029.
文摘BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma(HCC).METHODS We reviewed the medical records of 199 patients who underwent resection of HCC.Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography.Posthepatectomy liver failure(PHLF)was classified according to the International Study Group of Liver Surgery.Complications was classified according to Clavien–Dindo classification.We analyzed by the risk factors for PHLF,morbidity and mortality with multivariate analysis.RESULTS Twenty-seven(30%)patients had major complications and 23(12%)developed PHLF.The incidence of major complications increased with increasing albumin–bilirubin(ALBI)grade.The area under the curve values for hepatic clearance of the remnant liver,liver to heart-plus-liver radioactivity at 15 min(LHL15),and ALBI score predicting PHLF were 0.868,0.629,and 0.655,respectively.The area under the curve for hepatic clearance of the remnant liver,LHL15,and ALBI score predicting major complications were 0.758,0.594,and 0.647,respectively.The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.CONCLUSION The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.
