Summary

Posthepatectomy liver failure (PHLF) remains a life-threatening complication after hepatectomy. To reduce PHLF, a preoperative assessment of liver function is indispensable. For this purpose, 99mTc-mebrofenin hepatobiliary scintigraphy with SPECT (MSPECT) can be used. The aim of the current study was to evaluate the predictive value of MSPECT for PHLF in patients with non-colorectal liver tumors (NCRLT) compared to patients with colorectal liver metastasis (CRLM) undergoing extended liver resection.We included all patients undergoing extended liver resections via two-stage procedures between January 2019. and December 2021. at the University Medical Center Hamburg-Eppendorf, Germany. All patients received a preoperative MSPECT. Twenty patients were included. In every fourth patient, PHLF was observed. Four patients had PHLF grade C. There were no diferences between patients with CRLM and NCRLT regarding PHLF rate and future liver remnant (FLR) volume. Patients with CRLM had higher mebrofenin uptake in the FLR compared to those with NCRLT (2.49%/min/m² vs. 1.51%/min/m²; p = 0.004). Mebrofenin uptake in patients with NCRLT was lower compared to those patients with CRLM. However, there was no diference in the PHLF rate and FLR volume. Cut-of values for the mebrofenin uptake might need adjustments for diferent surgical indications, surgical procedures, and underlying diseases.

Keywords PHLF · Liver augmentation · Hepatobiliary scintigraphy · Extended liver resection

Results from AnyScan® TRIO SPECT/CT

Mebrofenin SPECT was performed using a triple-head camera (AnyScan® TRIO) equipped with LEHRHS collimators. The planar dynamic acquisition from the anterior and posterior view was started immediately after an intravenous bolus injection of approximately 200 MBq 99mTc-mebrofenin (ROTOP-EHIDA). A fast dynamic sequence was acquired with 38 frames of 10 s frame duration followed immediately by a SPECT with 60 frames of 8 s frame duration and additional low dose CT (100 kV, 30 mAs) for attenuation correction. The second dynamic sequence was started immediately after the SPECT/CT (20 frames of 60 s/frame). Image processing and quantifcation were performed as extensively described by Rassam et al. In short, a geometric mean dataset was generated using the dynamic sequences. Regions of interest (ROI) were defned in the frst dynamic sequence for the generation of time-activity curves (TAC) of the liver, left ventricle and whole feld of view. Using these TAC, the mebrofenin uptake rate (MUR) was calculated using the formula by Ekman et al. The calculated MUR in the percentage of the total administered Tc-99m-mebrofenin activity imbibed by the liver per minute was scaled by the body surface area. The functional distribution of the counts of the future liver remnant was determined in SPECT/CT after segmentation of the total liver and future liver remnant (InterView™ FUSION Processing Software, MEDISO). For delineation of FLR, recent contrast-enhanced imaging together with the low dose CT was used to defne anatomical landmarks.The activity within the intrahepatic bile ducts was replaced by average counts of the adjacent liver parenchyma. A ratio of the FLR counts and total liver counts as a percentage of total liver function was used to express the FLR function. Additionally, the biliary excretion rate of FLR in %/min was determined from the second dynamic scan using the described method. We used the cut-of value of 2.69%/min/m² as proposed by de Graaf et al.nto assess PHLF. Additionally, the average values for the mebrofenin uptake rate of the FLR were compared, and clinically relevant groups were stratifed accordingly.

Fig. 1 Clinical example of a patient (female, 56 years) with hepatic metastasis of colorectal cancer. A Geometric mean of the early frames of the frst dynamic sequence depicting the ROI of the left ventricle. B Geometric mean image of the frst dynamic sequence (150–350s) with ROI of the total liver. C Coronal slice of the SPECT CT fusion image depicting the mebrofenin uptake in the liver after ALPPS-procedure. D Transversal slice of the fused SPECT and CT after segmentation of the total liver, FRL, and intrahepatic bile ducts. E Time-activity curves of the frst dynamic scan for blood pool, liver, and whole feld-of-view used for calculation of MUR.

Table 1 Demographic and perioperative data stratifed according to the diagnosis

Table 2 Operative data of patients stratifed according to their diagnosis.

Fig. 2 The function of the future liver remnant (FLR) assessed by 99mTc-mebrofenin hepatobiliary scintigraphy with SPECT of both groups after augmentation is shown in a box plot. The diference in patients with colorectal liver metastasis (CRLM) and patients withn non-colorectal liver tumors (NCRPT) reaches signifcance (* = p < 0.005) while FLR showed no statistically signifcance between both groups (p> 0.05).

Conclusion

In this current study, mebrofenin uptake in the FLR was significantly lower in the NCLRT cohort than in the CRLM group, while FLR showed no significant differences between both groups. The results in this study are constrained by its retrospective design, leading to a heterogeneous population with variable therapies and indications. Furthermore, as described above, the small sample size might be responsible for insufficient statistical power to reproduce previously published data. Mebrofenin uptake in patients with NCRLT was statistically lower compared to those with CRLM but did not correlate with higher or lower rates of PHLF and FLR volume. Therefore, cut-off values for the uptake in the FLR might need adjustments for different surgical indications, surgical procedures, and underlying diseases.

Original link springer.com