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Usefulness of examining hepatic functional volume using technetium-99m galactosyl serum albumin scintigraphy in hepatocellular carcinoma

Nanashima, Atsushia; Abo, Takafumia; Kudo, Takashib; Sakamoto, Ichiroc; Hayashi, Hideyukic; Murakami, Goushia; Takeshita, Hiroakia; Hidaka, Shigekazua; Kido, Yasuob; Nagayasu, Takeshia

Nuclear Medicine Communications: May 2013 - Volume 34 - Issue 5 - p 478–488
doi: 10.1097/MNM.0b013e32835f945f
Original Articles

Objectives The aim of the study was to clarify the clinical significance of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging in terms of technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy. To this end, we examined the relationship using data from surgical records of 67 patients with hepatocellular carcinoma who underwent hepatectomy.

Materials and methods Liver functional parameters or functional volume was estimated by 99mTc-GSA scintigraphy and computed tomography volumetry was used to estimate morphological volume.

Results Liver uptake ratio at 15 min (LHL15) was correlated with the indocyanine green retention rate at 15 min (ICGR15; R=−0.608, P<0.01); however, five patients (7.5%) had values outside this correlation. In these patients, LHL15 reflected clinical status and patient outcomes more. Although morphological and functional volumes were well correlated (P<0.01), functional volume was decreased in the diseased liver with portal vein tumor thrombus or portal vein embolization. By applying 99mTc-GSA volumetry, portal pressure and alkaline phosphatase level were correlated with decreased volume of the embolized liver, and platelet count and cholesterol level were correlated with increased volume of the nonembolized liver (P<0.05). By measuring functional volume, four patients who were functionally borderline on the basis of the ICGR15 test safely underwent scheduled major hepatectomy.

Conclusion Under the ICGR15 test as the standard for preoperative hepatic function, auxiliary application of LHL15 and functional volumetry provides useful information on hepatocellular carcinoma patients undergoing hepatectomy.

aDepartment of Surgery, Division of Surgical Oncology

Departments of bRadioisotope Medicine

cRadiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

Correspondence to Atsushi Nanashima, MD, Department of Translational Medical Sciences, Division of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan Tel: +81 95 819 7304; fax: +81 95 819 7306; e-mail:

Received November 23, 2012

Accepted January 30, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins