Evaluation of hepatic functional reserve by 99mTc-GSA scintigraphy before and after treatment of liver cancer

Local therapies of liver cancer such as transcatheter arterial embolization (TAE), transcatheter arterial infusion (TAI) and radiofrequency ablation (RFA) are common. It has been pointed out that the liver function is reduced by repeating TAE and that in RFA the liver function is also reduced, especially in patients with a high Child-Pugh score after treatment. Therefore, the evaluation of preoperative hepatic functional reserve is vitally important for the selection of treatment methods. In the present study, the correlation between each index of scintigraphy with 99mTc-garactosyl human serum albumin (GSA), including HH15, LHL15 and LU15 as indices of hepatic functional reserve and conventional hepatic functional reserve was investigated before and after treatment of liver cancer. The subjects were 35 patients with liver cancer who were treated in hospital between April 2003 and January 2006 and examined by 99mTc-GSA scintigraphy before treatment. The total 35 patients were composed of 31 men and four women, aged 45 to 75 years (mean: 66.5 years), and details of background liver diseases were a positive hepatitis C virus (HCV) antibody in 32 patients, a positive hepatitis B virus (HBV) antigen in two and alcoholic liver disease in one. The methods of treatment of TAE in 27 patients and RFA in 8. Child-Pugh scores correlated with the respective indicators and the correlation with the LU15 value was the most significant. Indocyanine green (ICG) scores also correlated with the respective indices and the correlation with the LU15 value was the strongest. In multiple regression analysis, the LU15 value showed a significant correlation in the three indices assessed in the present study and was considered to be the most useful. There were no significant differences between Child-Pugh scores before and after treatment. There were neither significant differences between HH15 values before and after treatment nor significant differences between LHL15 values before and after treatment. 99mTc-GSA scintigraphy has been used as a preliminary index of liver function in many medical institutions but is considered useful for predicting the progression to postoperative liver failure by improvement in analysis and analysis per liver area by single photon emission computed tomography (SPECT). (author)