Three-Dimensional Quantitative Evaluation of the Segmental Functional Reserve in the Cirrhotic Liver Using Multi-Modality Imaging

Medicine (Baltimore). 2016 Mar;95(9):e2719. doi: 10.1097/MD.0000000000002719.

Abstract

To quantitatively evaluate the regional functional reserve in the cirrhotic liver and to seek related index that reflects diminished segmental liver function. A 3D system for quantitative evaluation of the liver was used to fuse technetium-99m galactosyl human serum albumin single-photon emission computed tomography and computed tomography images from 20 patients with cirrhotic liver and hepatocellular carcinoma. A set of parameters reflecting liver function including morphological liver volume, functional liver volume, functional liver density (FLD), and the drug absorption rate constant for hepatic cells (GSA-K) was calculated. Differences in FLD and GSA-K in intrahepatic segments were compared in patients with a tumor embolus (Group Y) and those without such an embolus (Group N) in the right portal vein. Differences in FLD and GSA-K in tumor-bearing (T+ group) and tumor-free (T- group) segments in patients with no tumor embolus (Group N) were also compared. Eleven living donor liver transplantation donor served as the control group. The FLD of the liver as a whole was significantly lower in patients with cirrhosis than in the control group (0.53 ± 0.13 vs 0.68 ± 0.10, P = 0.010). The FLD in segments of the right hemiliver was significantly lower than that in segments of the left hemiliver in Group Y (0.31 ± 0.21 vs 0.58 ± 0.12, P = 0.002) but not in Group N (0.60 ± 0.19 vs 0.55 ± 0.13, P = 0.294). FLD was 0.45 ± 0.17 in the T+ group and 0.60 ± 0.08 in the T- group (P = 0.008). Differences in GSA-K in intrahepatic segments were not significant. In the control group, differences in FLD and GSA-K in intrahepatic segments were not significant. The segmental liver functional reserve can be quantitatively calculated. FLD, but not GSA-K, is an index that reflects diminished regional liver function caused by portal flow obstruction or tumor compression.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / physiopathology
  • Female
  • Humans
  • Liver Cirrhosis* / pathology
  • Liver Cirrhosis* / physiopathology
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / physiopathology
  • Liver* / blood supply
  • Liver* / pathology
  • Liver* / physiopathology
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Organ Size
  • Portal Vein / physiopathology
  • Radiopharmaceuticals / pharmacology
  • Regional Blood Flow
  • Reproducibility of Results
  • Technetium Tc 99m Aggregated Albumin / pharmacology
  • Technetium Tc 99m Pentetate / pharmacology
  • Tomography, Emission-Computed, Single-Photon / methods
  • Tomography, X-Ray Computed / methods

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Aggregated Albumin
  • technetium Tc 99m DTPA-galactosyl-human serum albumin
  • Technetium Tc 99m Pentetate