Japanese Journal of Radiology

, Volume 30, Issue 3, pp 255–262 | Cite as

Fused 99m-Tc-GSA SPECT/CT imaging for the preoperative evaluation of postoperative liver function: can the liver uptake index predict postoperative hepatic functional reserve?

  • Morikatsu YoshidaEmail author
  • Shinya Shiraishi
  • Fumi Sakaguchi
  • Daisuke Utsunomiya
  • Kuniyuki Tashiro
  • Seiji Tomiguchi
  • Hirohisa Okabe
  • Toru Beppu
  • Hideo Baba
  • Yasuyuki Yamashita
Original article



To evaluate the role of hepatic asialoglycoprotein receptor analysis in the preoperative estimation of postoperative hepatic functional reserve.


We obtained technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-GSA) SPECT/CT fusion images in 256 patients with liver disease scheduled for hepatic resection. The liver uptake value corrected for body surface area [LUV(BSA)] and liver uptake ratio (LUR) of the remnant were preoperatively estimated based on the fused images. These values were compared with the postoperative hepatic functional reserve.


Significant correlations were observed between LUV(BSA), LUR, and most conventional indicators of hepatic functional reserve. Postoperatively, nonpreserved liver functional reserve was observed in 15 of the 256 patients (5.8%). Remnant LUV(BSA) showed better correlation than remnant LUR or the other indicators. No patients with remnant LUV(BSA) above 28.0 manifested poor nonpreserved functional reserve. Using a LUV(BSA) of 27.0, it was possible to predict postoperative poor hepatic functional reserve at a sensitivity of 91%, specificity of 81%, and accuracy of 81% postoperatively. According to multivariate analysis, a low remnant LUV(BSA) was the only significant independent predictor of poor hepatic functional reserve.


Our 99mTc-GSA SPECT/CT fusion imaging method was clinically useful for evaluating regional hepatic function and for predicting postoperative hepatic functional reserve.


Fusion imaging 99mTc-GSA SPECT Computed tomography Liver function Liver resection 


  1. 1.
    Hwang EH, Taki J, Shuke N, Nakajima K, Kinuya S, Konishi S, et al. Preoperative assessment of residual hepatic functional reserve using 99mTc-DTPA-galactosyl-human serum albumin dynamic SPECT. J Nucl Med. 1999;40(10):1644–51.PubMedGoogle Scholar
  2. 2.
    Kokudo N, Vera DR, Koizumi M, Seki M, Sato T, Stadalnik RC, et al. Recovery of hepatic asialoglycoprotein receptors after major hepatic resection. J Nucl Med. 1999;40(1):137–41.PubMedGoogle Scholar
  3. 3.
    Mitsumori A, Nagaya I, Kimoto S, Akaki S, Togami I, Takeda Y, et al. Preoperative evaluation of hepatic functional reserve following hepatectomy by technetium-99m galactosyl human serum albumin liver scintigraphy and computed tomography. Eur J Nucl Med. 1998;25(10):1377–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Stadalnik RC, Vera DR, Woodle ES, Trudeau WL, Porter BA, Ward RE, et al. Technetium-99m NGA functional hepatic imaging: preliminary clinical experience. J Nucl Med. 1985;26(11):1233–42.PubMedGoogle Scholar
  5. 5.
    Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26(5):1176–81.PubMedGoogle Scholar
  6. 6.
    Kwon AH, Matsui Y, Kaibori M, Ha-Kawa SK. Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection. Surgery. 2006;140(3):379–86.PubMedCrossRefGoogle Scholar
  7. 7.
    Madoff DC, Hicks ME, Vauthey JN, Charnsangavej C, Morello FA Jr, Ahrar K, et al. Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics. 2002;22(5):1063–76.PubMedGoogle Scholar
  8. 8.
    Matsuzaki S, Onda M, Tajiri T, Kim DY. Hepatic lobar differences in progression of chronic liver disease: correlation of asialoglycoprotein scintigraphy and hepatic functional reserve. Hepatology. 1997;25(4):828–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Kudo M, Todo A, Ikekubo K, Hino M. Receptor index via hepatic asialoglycoprotein receptor imaging: correlation with chronic hepatocellular damage. Am J Gastroenterol. 1992;87(7):865–70.PubMedGoogle Scholar
  10. 10.
    Kwon AH, Ha-Kawa SK, Uetsuji S, Kamiyama Y, Tanaka Y. Use of technetium 99m diethylenetriamine-pentaacetic acid-galactosyl-human serum albumin liver scintigraphy in the evaluation of preoperative and postoperative hepatic functional reserve for hepatectomy. Surgery. 1995;117(4):429–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Vera DR, Stadalnik RC, Trudeau WL, Scheibe PO, Krohn KA. Measurement of receptor concentration and forward-binding rate constant via radiopharmacokinetic modeling of technetium-99m-galactosyl-neoglycoalbumin. J Nucl Med. 1991;32(6):1169–76.PubMedGoogle Scholar
  12. 12.
    Ha-Kawa SK, Tanaka Y. A quantitative model of technetium-99m-DTPA-galactosyl-HSA for the assessment of hepatic blood flow and hepatic binding receptor. J Nucl Med. 1991;32(12):2233–40.PubMedGoogle Scholar
  13. 13.
    Miki K, Kubota K, Kokudo N, Inoue Y, Bandai Y, Makuuchi M. Asialoglycoprotein receptor and hepatic blood flow using technetium-99m-DTPA-galactosyl human serum albumin. J Nucl Med. 1997;38(11):1798–807.PubMedGoogle Scholar
  14. 14.
    Shuke N, Okizaki A, Kino S, Sato J, Ishikawa Y, Zhao C, et al. Functional mapping of regional liver asialoglycoprotein receptor amount from single blood sample and SPECT. J Nucl Med. 2003;44(3):475–82.PubMedGoogle Scholar
  15. 15.
    Kaibori M, Ha-Kawa SK, Ishizaki M, Matsui K, Saito T, Kwon AH, et al. HA/GSA-Rmax ratio as a predictor of postoperative liver failure. World J Surg. 2008;32(11):2410–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Beppu T, Hayashi H, Okabe H, Masuda T, Mima K, Otao R, et al. Liver functional volumetry for portal vein embolization using a newly developed (99m)Tc-galactosyl human serum albumin scintigraphy SPECT-computed tomography fusion system. J Gastroenterol. 2011;46(7):938–43Google Scholar
  17. 17.
    Slankamenac K, Breitenstein S, Held U, Beck-Schimmer B, Puhan MA, Clavien PA. Development and validation of a prediction score for postoperative acute renal failure following liver resection. Ann Surg Clin Trial Valid Stud. 2009;250(5):720–8.Google Scholar
  18. 18.
    Sugahara K, Togashi H, Takahashi K, Onodera Y, Sanjo M, Misawa K, et al. Separate analysis of asialoglycoprotein receptors in the right and left hepatic lobes using Tc-GSA SPECT. Hepatology. 2003;38(6):1401–9.PubMedGoogle Scholar
  19. 19.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8. discussion 8–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Paugam-Burtz C, Janny S, Delefosse D, Dahmani S, Dondero F, Mantz J, et al. Prospective validation of the “fifty–fifty” criteria as an early and accurate predictor of death after liver resection in intensive care unit patients. Ann Surg. 2009;249(1):124–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397–406, discussion 7.Google Scholar
  22. 22.
    Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188(3):304–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Ashwell G, Morell AG. The role of surface carbohydrates in the hepatic recognition and transport of circulating glycoproteins. Adv Enzymol Relat Areas Mol Biol. 1974;41:99–128.PubMedGoogle Scholar
  24. 24.
    Marshall JS, Green AM, Pensky J, Williams S, Zinn A, Carlson DM. Measurement of circulating desialylated glycoproteins and correlation with hepatocellular damage. J Clin Invest. 1974;54(3):555–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Sawamura T, Kawasato S, Shiozaki Y, Sameshima Y, Nakada H, Tashiro Y. Decrease of a hepatic binding protein specific for asialoglycoproteins with accumulation of serum asialoglycoproteins in galactosamine-treated rats. Gastroenterology. 1981;81(3):527–33.PubMedGoogle Scholar
  26. 26.
    Kwon AH, Ha-Kawa SK, Uetsuji S, Inoue T, Matsui Y, Kamiyama Y. Preoperative determination of the surgical procedure for hepatectomy using technetium-99m-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy. Hepatology. 1997;25(2):426–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Sasaki N, Shiomi S, Iwata Y, Nishiguchi S, Kuroki T, Kawabe J, et al. Clinical usefulness of scintigraphy with 99mTc-galactosyl-human serum albumin for prognosis of cirrhosis of the liver. J Nucl Med. 1999;40(10):1652–6.PubMedGoogle Scholar
  28. 28.
    Kira T, Tomiguchi S, Takahashi M, Yoshimatsu S, Sagara K, Kurano R. Correlation of 99mTc-GSA hepatic scintigraphy with liver biopsies in patients with chronic active hepatitis type C. Radiat Med. 1999;17(2):125–30.PubMedGoogle Scholar
  29. 29.
    Seo Y, Mari C, Hasegawa BH. Technological development and advances in single-photon emission computed tomography/computed tomography. Semin Nucl Med. 2008;38(3):177–98.PubMedCrossRefGoogle Scholar
  30. 30.
    Yumoto Y, Yagi T, Sato S, Nouso K, Kobayashi Y, Ohmoto M, et al. Preoperative estimation of remnant hepatic function using fusion images obtained by (99m)Tc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography. Br J Surg. 2010;97(6):934–44.PubMedCrossRefGoogle Scholar
  31. 31.
    Bachellier P, Rosso E, Pessaux P, Oussoultzoglou E, Nobili C, Panaro F, et al. Risk factors for liver failure and mortality after hepatectomy associated with portal vein resection. Ann Surg. 2011;253(1):173–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Mathur AK, Ghaferi AA, Osborne NH, Pawlik TM, Campbell DA, Englesbe MJ, et al. Body mass index and adverse perioperative outcomes following hepatic resection. J Gastrointest Surg. 2010;14(8):1285–91.PubMedCrossRefGoogle Scholar
  33. 33.
    Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ. Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg. 2009;250(6):1014–20.PubMedCrossRefGoogle Scholar
  34. 34.
    Wei AC, Tung-Ping Poon R, Fan ST, Wong J. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg. 2003;90(1):33–41.PubMedCrossRefGoogle Scholar
  35. 35.
    Takenaka K, Kanematsu T, Fukuzawa K, Sugimachi K. Can hepatic failure after surgery for hepatocellular carcinoma in cirrhotic patients be prevented? World J Surg. 1990;14(1):123–7.PubMedCrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2012

Authors and Affiliations

  • Morikatsu Yoshida
    • 1
    Email author
  • Shinya Shiraishi
    • 1
  • Fumi Sakaguchi
    • 1
  • Daisuke Utsunomiya
    • 1
  • Kuniyuki Tashiro
    • 2
  • Seiji Tomiguchi
    • 3
    • 4
  • Hirohisa Okabe
    • 3
    • 4
  • Toru Beppu
    • 3
    • 4
  • Hideo Baba
    • 3
    • 4
  • Yasuyuki Yamashita
    • 1
  1. 1.Department of Diagnostic Radiology, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
  2. 2.Kumamoto City HospitalKumamotoJapan
  3. 3.Department of Diagnostic Radiology, School of Health SciencesKumamoto UniversityKumamotoJapan
  4. 4.Department of Gastroenterological Surgery, Faculty of Life SciencesKumamoto UniversityKumamotoJapan

Personalised recommendations