Variations between the anatomical and functional distribution, based on 99m technetium -mebrofinate SPECT-CT scan, in patients at risk of post hepatectomy liver failure

Abstract

Background: The aim of the current study is to investigate the variations of anatomical (LV_Rem%) and functional remnant volumes (fLV_Rem%) and the dynamic uptake of Technetium-Mebrofinate (FRLF) measured from 99^m Technetium-Mebrofinate SPECT-CT scan (TMSCT) in patients at high risk of post-hepatectomy liver failure (PHLF).

Methods: Variations in the measures of LV_Rem% and fLV_Rem% were assessed. The predictive accuracies of LV_Rem%, fLV_Rem% and FRLF with respect to PHLF were reported.

Results: From the N = 92 scans performed, LV_Rem% and fLV_Rem% returned identical results in 15% of cases, and ±10 percentage points in 79% of cases. Some patients had larger discrepancies, with difference of >10 percentage points in 21% of cases. The difference was significant in those with primary liver cancers (-4.4 ± 9.2, p = 0.002). For the N = 29 patients that underwent surgery as planned on TMSCT, FRLF was a strong predictor of PHLF, with an AUROC of 0.83 (p = 0.005).

Conclusion: TMSCT is emerging as a useful modality in pre-operative assessment of patients undergoing major liver resection. For those with primary liver cancer, there is a significant variation in the anatomical and functional distributions that needs considered in surgical planning. Reduced FRLF, measured as the dynamic uptake in the future liver remnant, is a strong predictor of PHLF.