Dynamic [99mTc]Tc-mebrofenin SPECT/CT in preoperative planning of liver resection: a prospective study

Abstract

Background: At least 20% of the future liver remnant must function properly after liver tumor resection to avoid post-hepatectomy liver failure (PHLF). [99mTc]Tc-mebrofenin scintigraphy and SPECT are unique noninvasive, quantitative methods for evaluating liver function via hepatocellular bilirubin clearance. Aim: To evaluate the value of dynamic [99mTc]Tc-mebrofenin SPECT/CT parameters for predicting clinically relevant PHLF according to the ISGLS criteria. Methods: Thirty-five patients underwent dynamic [99mTc]Tc-mebrofenin SPECT/CT imaging to determine the FLR volumetric rate, functional volume rate, total liver filtration and FLR filtration. On the same day, two-dimensional ultrasound shear wave elastography (2D-SWE) was used to assess parenchymal fibrosis in the FLR. The quantitative dynamic SPECT parameters were compared with the relevant clinical scores and ICG. Results: The total liver filtration was inversely correlated with the ICG-R15 and MELD-Na score. Twenty-four patients underwent major liver resection due to an adequate FLR rate and did not die within 90 days after the procedure. ROC analysis revealed that the FLR filtration was a significant predictor of PHLF. The best cutoff value for FLR filtration was 2.72%/min/m2. Conclusion: Dynamic [99mTc]Tc-mebrofenin SPECT/CT is an essential tool for selecting patients at risk of clinically relevant PHLF after liver resection.