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

Jpn J Radiol. 2019 Apr;37(4):315-320. doi: 10.1007/s11604-019-00810-w. Epub 2019 Jan 17.


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

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hepatectomy
  • Humans
  • Liver / diagnostic imaging
  • Liver / pathology
  • Liver / surgery
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / surgery
  • Liver Function Tests
  • Male
  • Middle Aged
  • ROC Curve
  • Radiopharmaceuticals*
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Single Photon Emission Computed Tomography Computed Tomography / methods*
  • Technetium Tc 99m Aggregated Albumin*
  • Technetium Tc 99m Pentetate*


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