Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Eur Surg Res. 2018;59(1-2):12-22. doi: 10.1159/000484044. Epub 2018 Jan 12.


Background: Posthepatectomy liver failure (PHLF) was recently defined with the corresponding recommendations as follows: grade A, no change in clinical management; grade B, clinical management with noninvasive treatment; and grade C, clinical management with invasive treatment. In this study, we identified the risk factors for grade B and C PHLF in patients with hepatocellular carcinoma (HCC).

Methods: Of 339 HCC patients who underwent curative hepatic resection, 218 were included for analysis. The LHL15 index (uptake ratio of the liver to that of the liver and heart at 15 min) was measured by 99m Tc-GSA (99m technetium-labelled galactosyl human serum albumin); remnant LHL15 was calculated as LHL15 × [1 - (resected liver weight - tumor volume)/whole liver volume without tumor].

Results: A total of 163 patients were classified as having no PHLF, whereas 17, 37, and 1 patient had PHLF grade A, B, and C, respectively. There were significant differences in indocyanine green R15, serum albumin, prothrombin time, Child-Pugh classification, LHL15 and remnant LHL15 between patients with grades B/C PHLF and patients with grade A or no PHLF. Only remnant LHL15 was identified as an independent risk factor for grades B/C PHLF (p = 0.023), with a cut-off value of 0.755.

Conclusions: Remnant LHL15 was an independent risk factor for grades B/C PHLF. Patients with impaired remnant LHL15 value of <0.755 should be carefully monitored for PHLF.

Keywords: 99m Tc-GSA; LHL15 index; Liver failure; Liver resection; Posthepatectomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / surgery*
  • Female
  • Hepatectomy / adverse effects*
  • Humans
  • Liver Failure / diagnostic imaging
  • Liver Failure / etiology*
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Risk Factors
  • Technetium Tc 99m Aggregated Albumin*
  • Technetium Tc 99m Pentetate*
  • Tomography, Emission-Computed, Single-Photon / methods*


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