Prediction of Liver Failure after Right Hepatectomy with ^99mTc-GSA SPECT Scintigraphy

Ryoichi Yokota, Hiroyuki Ishizu, Yukifumi Kondo, Kuniaki Okada, Hiroyuki Masuko, Tsunetake Hata, Hideki Kawamura, Kei Ohara, Hiroshi Toi and Shigeru Nishino*

Department of Surgery and Department of Radiology*, Sapporo Kosei Hospital

Background: Prediction of postoperative remnant liver function is more important than the estimation of preoperative whole liver function in avoiding liver failure after hepatectomy. Methods: We evaluated liver function before and after right hepatic lobectomy with single photon emission computed tomography (SPECT) of technetium-99m-galactosyl human serum albumin (^99mTc-GSA) scintigraphy. The GSA index was calculated by LHL15/HH15. The estimated left GSA index was calculated by integrating SPECT in the residual left lobe before hepatectomy. Results: The estimated left GSA index correlated well with the actual GSA index 2 weeks after hepatectomy. GSA indices 2 weeks after hepatectomy were below 1.15 in 2 patients who had liver dysfunction such as abdominal ascites and hyperammoniemia. Their estimated left GSA indices were also low. Discussion: A patient with an estimated left GSA index below 0.38 is at risk for liver failure after right lobectomy. The estimated residual GSA index has a potency of a novel determinant of liver function estimating for post operative liver failure.

Key words
^99mTc-GSA scintigraphy, hepatectomy, remnant liver function, liver failure

Reprint requests
Ryoichi Yokota Department of Surgery, Nakashibetsu Town Hospital
1-1 Nishi 10 Jo, Minani 9 chome, Nakashibetsu-cho, Shibetsu-gun, 086-1110 JAPAN

Accepted
November 30, 2005

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