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Liver fibrosis assessment using 99mTc-GSA SPECT/CT fusion imaging

  • Ryotaro Tokorodani
  • Tatsuaki SumiyoshiEmail author
  • Takehiro Okabayashi
  • Yasuhiro Hata
  • Yoshihiro Noda
  • Sojiro Morita
  • Hiromitsu Daisaki
  • Yukinori Okada
  • Eisuke Yasuda
Original Article
  • 29 Downloads

Abstract

Purpose

To determine the utility of mean standardized uptake value (SUVmean) of whole liver measured by 99mTc-GSA SPECT/CT fusion imaging, for evaluation of liver fibrosis.

Materials and methods

Eighty-six patients who underwent hepatectomy were enrolled, and were classified into the non-fibrosis or fibrosis group based on the pathological findings in the resected liver specimen. Univariate and multivariate analyses were performed between the two groups on four blood biochemical indices (albumin, total bilirubin, platelet count, and prothrombin time activity) and two 99mTc-GSA scintigraphy-derived liver function indices (LHL15 and SUVmean) to evaluate the independent predictive value for severe fibrosis. The diagnostic value of the index for severe fibrosis was assessed by calculating the area under the receiver operating characteristic curve.

Results

Multivariate analysis showed that prothrombin time activity [odds ratio (OR) 0.519], LHL15 (OR 0.513), and SUVmean (OR 0.168) significantly correlated with liver fibrosis. SUVmean showed the largest area under the curve, with value of 0.804, 0.730 for platelet count, 0.717 for LHL15, and 0.668 for prothrombin time activity. The optimal cut-off value for SUVmean was 6.7, which yielded 62.9% sensitivity and 96.9% specificity.

Conclusions

SUVmean measured by 99mTc-GSA SPECT/CT fusion imaging enables highly accurate prediction of severe liver fibrosis.

Keywords

Liver fibrosis Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin single-photon-emission computed tomography Standardized uptake value 

Notes

Funding

We received no financial support.

Compliance with ethical standards

Conflict of interest

We have no conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethics committee of the Kochi Health Sciences Center and with the 1964 Helsinki declaration. The study was approved by the institutional review board of Kochi Health Sciences Center, with a waiver of informed consent.

References

  1. 1.
    Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J. Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg. 1999;229:210–5.CrossRefGoogle Scholar
  2. 2.
    Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72.CrossRefGoogle Scholar
  3. 3.
    Zarzavadjian A, Bian L, Costi R, Sbai-Idrissi MS, Smadja C. Liver resection and metabolic disorders: an undescribed mechanism leading to postoperative mortality. World J Gastroenterol. 2014;20:55–62.Google Scholar
  4. 4.
    Wang Q, Fiel M, Blank S, Luan W, Kadri H, Kim KW, et al. Impact of liver fibrosis on prognosis following liver resection for hepatitis B-associated hepatocellular carcinoma. Br J Cancer. 2013;109:573–81.CrossRefGoogle Scholar
  5. 5.
    Sumiyoshi T, Shima Y, Okabayashi T, Noda Y, Hata Y, Murata Y, et al. Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer: an appraisal using 99mTc-GSA SPECT/CT fusion. Radiology. 2014;273:444–51.CrossRefGoogle Scholar
  6. 6.
    Sobue G, Kosaka A. Asialoglycoproteinemia in a case of primary hepatic cancer. Hepatogastroenterology. 1980;27:200–3.Google Scholar
  7. 7.
    Marshall JS, Green AM, Pensky J, Williams S, Zinn A, Carlson DM. Measurement of circulating desialylated glycoproteins and correlation with hepatocellular damage. J Clin Investig. 1974;54:555–62.CrossRefGoogle Scholar
  8. 8.
    Okabayashi T, Shima Y, Morita S, Shimada Y, Sumiyoshi T, Sui K, et al. Liver function assessment using technetium 99m-Galactosyl single-photon emission computed tomography/CT fusion imaging: a prospective trial. J Am Coll Surg. 2017;225:789–97.CrossRefGoogle Scholar
  9. 9.
    Okabe H, Beppu T, Hayashi H, Mima K, Nakagawa S, Kuroki H, et al. Rank classification based on the combination of indocyanine green retention rate at 15 min and (99m) Tc-DTPA-galactosyl human serum albumin scintigraphy predicts the safety of hepatic resection. Nucl Med Commun. 2014;35:478–83.CrossRefGoogle Scholar
  10. 10.
    Hasegawa D, Onishi H. Evaluation of accuracy for quantitative predictor of hepatic functional reserve using planar and SPECT images in the 99mTc-GSA scintigraphy. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2017;73:1055–60.CrossRefGoogle Scholar
  11. 11.
    Suh MS, Lee WW, Kim YK, Yun PY, Kim SE. Maximum standardized uptake value of 99mTc hydroxymethylene diphosphonate SPECT/CT for the evaluation of temporomandibular joint disorder. Radiology. 2016;280:890–6.CrossRefGoogle Scholar
  12. 12.
    Kinahan PE, Fletcher JW. Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy. Semin Ultrasound CT MR. 2010;31:496–505.CrossRefGoogle Scholar
  13. 13.
    Kokudo N, Vera DR, Makuuchi M. Clinical application of TcGSA. Nucl Med Biol. 2003;30:845–9.CrossRefGoogle Scholar
  14. 14.
    Kwon AH, Ha-Kawa SK, Uetsuji S, Kamiyama Y, Tanaka Y. Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection. Surgery. 1995;117:429–34.CrossRefGoogle Scholar
  15. 15.
    Oshiro Y, Ohkohchi N. Three-dimensional liver surgery simulation: computer-assisted surgical planning with three-dimensional simulation software and three-dimensional printing. Tissue Eng Part A. 2017;23:474–80.CrossRefGoogle Scholar
  16. 16.
    Ludwig J (1993) The nomenclature of chronic active hepatitis: an obituary. Gastroenterology 105:274–278Google Scholar
  17. 17.
    Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V et al (2007) FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest. Hepatology 46:32–36Google Scholar
  18. 18.
    Jabor A, Kubíček Z, Fraňková S, Šenkeříková R, Franeková J. Enhanced liver fibrosis (ELF) score: Reference ranges, biological variation in healthy subjects, and analytical considerations. Clin Chim Acta. 2018;483:291–5.CrossRefGoogle Scholar
  19. 19.
    Gudowska M, Cylwik B, Chrostek L. The role of serum hyaluronic acid determination in the diagnosis of liver fibrosis. Acta Biochim Pol. 2017;64:451–7.CrossRefGoogle Scholar
  20. 20.
    Khan S, Subedi D, Chowdhury UMM (2006) Use of amino terminal type III procollagen peptide (P3NP) assay in methotrexate therapy for psoriasis. Postgrad Med J 82:353–354Google Scholar
  21. 21.
    Murawaki Y, Ikuta Y, Nishimura Y, Koda M, Kawasaki H. Serum markers for connective tissue turnover in patients with chronic hepatitis B and chronic hepatitis C: a comparative analysis. J Hepatol. 1995;23:145–52.CrossRefGoogle Scholar
  22. 22.
    Bulatova IA, Schekotova AP, KrivtsovAV, Schekotov VV, Pavlov AI (2015) The noninvasive evaluation of degree of expression of fibrosis of liver and significance of polymorphism of gene of hyaluronic acid under chronic hepatitis C. Klin Lab Diagn 60:18–21Google Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  • Ryotaro Tokorodani
    • 1
    • 6
  • Tatsuaki Sumiyoshi
    • 2
    Email author
  • Takehiro Okabayashi
    • 2
  • Yasuhiro Hata
    • 3
  • Yoshihiro Noda
    • 3
  • Sojiro Morita
    • 3
  • Hiromitsu Daisaki
    • 4
  • Yukinori Okada
    • 5
  • Eisuke Yasuda
    • 6
  1. 1.Department of Radiological TechnologyKochi Health Sciences CenterKochiJapan
  2. 2.Department of Gastroenterological SurgeryKochi Health Sciences CenterKochiJapan
  3. 3.Department of RadiologyKochi Health Sciences CenterKochiJapan
  4. 4.Department of Gunma Prefectural College of Health SciencesMaebashiJapan
  5. 5.Department of RadiologySt. Marianna University School of MedicineKawasakiJapan
  6. 6.Department of Radiological Technology, Graduate School of Health ScienceSuzuka University of Medical ScienceSuzukaJapan

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