technetium-tc-99m-mebrofenin and Liver-Failure

Portal vein embolization consists of occluding a part of the portal venous system in order to achieve the hypertrophy of the non-embolized liver segments. This technique is used during the preoperative period of major liver resection when the future remnant liver (FRL) volume is insufficient, exposing to postoperative liver failure, main cause of death after major hepatectomy. Portal vein embolization indication depends on the FRL, commonly assessed by its volume. Nowadays, FRL function evaluation seems more relevant and can be measured by 99mTc labelled mebrofenin scintigraphy. Portal vein embolization procedure is mostly performed with percutaneous trans-hepatic access by using ultrasonography guidance and consists of embolic agent injection, such as cyanoacrylate, in the targeted portal vein branches with fluoroscopic guidance. It is a safe and well-tolerated technique, with extremely low morbi-mortality. Portal vein embolization leads to sufficient FRL hypertrophy in about 80% of patients, allowing them to undergo surgery from which they were initially rejected. The two main reasons of non-resection are tumor progression (≈15% of cases) and FRL insufficient hypertrophy (≈5% of cases). When portal vein embolization is not enough to obtain adequate FRL regeneration, hepatic vein embolization may potentiate its effect (liver venous deprivation technique).

Topics: Aniline Compounds; Chemotherapy, Adjuvant; Cyanoacrylates; Embolization, Therapeutic; Glycine; Hepatectomy; Humans; Hypertrophy; Imino Acids; Liver; Liver Failure; Liver Neoplasms; Liver Regeneration; Middle Aged; Organotechnetium Compounds; Portal Vein; Preoperative Care

A major part of morbidity and mortality after liver resections is caused by inadequate remnant liver function leading to liver failure. It is therefore important to develop accurate diagnostic tools that can predict the risk of liver resection-related morbidity and mortality. In this study, preoperative hepatobiliary scintigraphy of the future remnant liver and CT volumetric measurement of the future remnant liver were performed on patients who were to undergo liver resection. The accuracy of risk assessment for postoperative morbidity, liver failure, and mortality was evaluated.. Forty-six patients who were scheduled for liver resection because of hepatobiliary tumors, including 17 patients with parenchymal disease (37%) and 13 patients with hilar cholangiocarcinoma (28%), were assessed preoperatively. Hepatobiliary scintigraphy was performed by drawing regions of interest around the future remnant to calculate (99m)Tc-mebrofenin uptake in it. CT volumetry was used to measure the volume of the total liver, the tumors, and the future remnant. Receiver-operating-characteristic analysis was performed to assess cutoff values for risk assessment of morbidity, liver failure, and mortality. Furthermore, univariate and multivariate analyses were performed to determine factors related to morbidity and mortality.. Morbidity and mortality rates were 61% and 11%, respectively. Liver failure occurred in 6 patients (13%). Significantly decreased uptake in the future remnant was found in patients in whom liver failure and liver failure-related mortality developed (P=0.003 and 0.02, respectively). The volume of the future remnant was not significantly associated with any of the outcome parameters. In receiver-operating-characteristic analysis, uptake cutoff values for liver failure and liver failure-related mortality were 2.5%/min/body surface area and 2.2%/min/body surface area, respectively. In multivariate analysis, uptake was the only significant factor associated with liver failure.. Preoperative measurement of (99m)Tc-mebrofenin uptake in the future remnant liver on hepatobiliary scintigraphy proved more valuable than measurement of the volume of the future remnant on CT in assessing the risk of liver failure and liver failure-related mortality after partial liver resection.

Topics: Adult; Aged; Aniline Compounds; Biliary Tract; Comorbidity; Female; Glycine; Hepatectomy; Humans; Imaging, Three-Dimensional; Imino Acids; Liver; Liver Failure; Liver Neoplasms; Male; Middle Aged; Netherlands; Organotechnetium Compounds; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Survival Analysis; Survival Rate; Tomography, X-Ray Computed

There is a growing interest in assessment of future remnant liver function with Tc-mebrofenin hepatobiliary scintigraphy before major hepatectomy to estimate the risk of posthepatectomy liver failure. We illustrate the case of a 42-year-old woman with liver metastasis from colorectal cancer who performed hepatobiliary scintigraphy. Tc-mebrofenin clearance rate of the total liver was considerably low. The patient recently started a treatment for active hepatitis C with a combination of 2 new direct-acting antiviral agents (grazoprevir, elbasvir). Apart from hypoalbuminemia or hyperbilirubinemia, physicians must be aware that drug interactions can interfere with Tc-mebrofenin liver uptake, thereby resulting in a dramatic underestimation of liver function.

Topics: Adult; Amides; Aniline Compounds; Antiviral Agents; Benzofurans; Carbamates; Cyclopropanes; Drug Interactions; Female; Glycine; Hepacivirus; Humans; Imidazoles; Imino Acids; Liver Failure; Organotechnetium Compounds; Quinoxalines; Radionuclide Imaging; Radiopharmaceuticals; Sulfonamides

Topics: Aniline Compounds; Clinical Decision Rules; Glycine; Hepatectomy; Humans; Imino Acids; Liver; Liver Failure; Liver Function Tests; Liver Regeneration; Middle Aged; Organ Size; Organotechnetium Compounds; Postoperative Complications; Radiopharmaceuticals; Risk Assessment; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to evaluate interstage liver function in associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) using hepatobiliary scintigraphy (HBS) and whether this may help to predict posthepatectomy liver failure (PHLF).. ALPPS remains controversial given the high rate of liver-related mortality after stage 2. HBS combined with single photon emission computed tomography (SPECT) accurately estimates future liver remnant function and may be useful to predict PHLF.. Between 2011 and 2016, 20 of 39 patients (51.3%) underwent SPECT-HBS before ALPPS stage 2 for primary (n = 3) or secondary liver tumors (n = 17) at the Hospital Italiano de Buenos Aires (HIBA). PHLF was defined by the International Study Group of Liver Surgery criteria, 50-50 criteria, or peak bilirubin >7 mg/dL. Grade A PHLF was excluded, as it requires no change in clinical management. Receiver-operating characteristic curves were used to determine cutoff for HBS parameters.. Interstagely, 3 HBS parameters differed significantly between patients with (n = 4) and without PHLF (n = 16) after stage 2. Among these, the HIBA-index best predicted PHLF, with a cutoff value of 15%. The risk of PHLF in patients with cutoff <15% was 80%, whereas no patient with cutoff ≥15% developed PHLF.. Interstage HBS could help to predict clinically significant PHLF after ALPPS stage 2. An HIBA-index cutoff of 15% seemed to give the best diagnostic performance. Although further studies are needed to confirm our findings, the routine application of this noninvasive low-cost examination could facilitate decision-making in institutions performing ALPPS.

Topics: Aged; Aniline Compounds; Female; Glycine; Hepatectomy; Humans; Imino Acids; Liver; Liver Failure; Male; Middle Aged; Organ Size; Organotechnetium Compounds; Portal Vein; Postoperative Complications; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

Posthepatectomy liver failure (PHLF) is a threatening complication after liver surgery, especially in perihilar cholangiocarcinoma (PHC). This study aimed to assess the value of preoperative assessment of liver function using. All patients who underwent resection of suspected PHC in a single center between 2000 and 2015 were included in the analysis. PHLF was graded according to the ISGLS criteria with grade B/C considered clinically relevant. A cut-off value for the prediction of PHLF was calculated using the receiver operating characteristic curve (ROC) analysis.. A total of 116 patients were included of which 27 (23%) suffered of PHLF. ROC values for the prediction of PHLF were 0.74 (0.63-0.86) for future liver remnant function and 0.63 (0.47-0.80) for volume. A cut-off for liver function was set at 8.5%/min, which resulted in a negative predictive value of 94% and positive predictive value of 41%.. Assessment of liver function with HBS had better predictive value for PHLF than liver volume in patients undergoing major liver resection for suspected PHC. The cut-off of 8.5%/min can help to select patients for portal vein embolization and might help to reduce postoperative liver failure.

Topics: Aged; Aniline Compounds; Area Under Curve; Bile Duct Neoplasms; Female; Glycine; Hepatectomy; Humans; Imino Acids; Klatskin Tumor; Liver Failure; Liver Function Tests; Male; Middle Aged; Neoplasm Grading; Netherlands; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Risk Factors; ROC Curve; Single Photon Emission Computed Tomography Computed Tomography; Treatment Outcome

Recently, there has been increasing interest in the preoperative prediction and prevention of post-hepatectomy liver failure (PHLF). This is a particular concern in colorectal liver metastases (CRLM), when surgery follows potentially hepatotoxic chemotherapy. Platelet-based liver scores (PBLS) such as APRI and FIB-4 are predictive of chemotherapy-associated liver injury (CALI) and PHLF. Estimation of the future liver remnant function (eFLRF) by combining. Between 2012 and 2016, 140 patients underwent liver resection for CRLM following systemic therapy. HBS. eFLRF and FLRV% had a better predictive value for PHLF than HBS. eFLRF is a better predictor of PHLF than PBLS or HBS

Topics: Aniline Compounds; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Colorectal Neoplasms; Female; Glycine; Hepatectomy; Humans; Imino Acids; Irinotecan; Liver Failure; Liver Function Tests; Liver Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Organotechnetium Compounds; Oxaliplatin; Platelet Function Tests; Predictive Value of Tests; Radiopharmaceuticals; Treatment Outcome

The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase.. eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m. Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery.. eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.. • eLVD is safe • eLVD provides a marked and very rapid increase in liver function • After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21 • After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%) • After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day).

Topics: Aged; Aniline Compounds; Bile Duct Neoplasms; Embolization, Therapeutic; Female; Gallbladder Neoplasms; Glycine; Hepatectomy; Hepatic Veins; Humans; Imino Acids; Klatskin Tumor; Liver; Liver Failure; Liver Function Tests; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Portal Vein; Preoperative Care; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Tomography, X-Ray Computed

Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate and is likely to happen in insufficient liver remnant. We hypothesize that assessment of the estimated future liver remnant function (eFLRF), combining future remnant liver volume (FLRV) with total liver function (TLF), is an accurate formula for prediction of PHLF.. 88 patients undergoing hepatectomy were included. The ratio of the future liver remnant volume (FLRV%) was measured on MRI. TLF was estimated by liver clearance of (99m)Technetium (Tc)-mebrofenin on hepatobiliary scintigraphy (HBS). eFLRF was calculated by multiplying FLRV% by TLF. Cut-off values of FLRV% and eFLRF predicting PHLF, were defined by receiver-operating-characteristic (ROC) analysis.. PHLF occurred in 12 patients (13%). Perioperative mortality was 5/12 (41%). Multivariate analysis showed that FLRV% cut off at 40% was not an independent predictive factor. eFLRF cut off at 2.3%/min/m(2) was the only independent predictive factor for PHLF. For FLRV% vs. eFLRF, positive predictive value was 41% vs. 92% and Odds Ratio 26 vs. 836.. FRLF measured by combining FLRV% and TLF is a more valuable tool to predict PHLF than FLRV% alone. The cutoff of eFLRF can be used in clinical decision making.

Topics: Aged; Aniline Compounds; Area Under Curve; Female; Glycine; Hepatectomy; Humans; Imino Acids; Liver; Liver Failure; Liver Function Tests; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Organ Size; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Risk Factors; ROC Curve; Treatment Outcome

(99m)Tc-mebrofenin-hepatobiliary-scintigraphy (HBS) enables measurement of future remnant liver (FRL)-function and was implemented in our preoperative routine after calculation of the cut-off value for prediction of postoperative liver failure (LF). This study evaluates our results since the implementation of HBS. Additionally, CT-volumetric methods of FRL-assessment, standardized liver volumetry and FRL/body-weight ratio (FRL-BWR), were evaluated.. 163 patients who underwent major liver resection were included. Insufficient FRL-volume and/or FRL-function <2.7%/min/m(2) were indications for portal vein embolization (PVE). Non-PVE patients were compared with a historical cohort (n = 55). Primary endpoints were postoperative LF and LF related mortality. Secondary endpoint was preoperative identification of patients at risk for LF using the CT-volumetric methods.. 29/163 patients underwent PVE; 8/29 patients because of insufficient FRL-function despite sufficient FRL-volume. According to FRL-BWR and standardized liver volumetry, 16/29 and 11/29 patients, respectively, would not have undergone PVE. LF and LF related mortality were significantly reduced compared to the historical cohort. HBS appeared superior in the identification of patients with increased surgical risk compared to the CT-volumetric methods.. Implementation of HBS in the preoperative work-up led to a function oriented use of PVE and was associated with a significant decrease in postoperative LF and LF related mortality.

Topics: Aged; Aniline Compounds; Embolization, Therapeutic; Female; Glycine; Hepatectomy; Humans; Imino Acids; Liver; Liver Failure; Liver Function Tests; Male; Middle Aged; Organ Size; Organotechnetium Compounds; Portal Vein; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Treatment Outcome

(99m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) was used as a quantitative method to evaluate liver function. The aim of this study was to compare future remnant liver function assessed by (99m)Tc-mebrofenin hepatobiliary scintigraphy with future remnant liver volume in the prediction of liver failure after major liver resection.. Computed tomography (CT) volumetry and (99m)Tc-mebrofenin hepatobiliary scintigraphy were performed prior to major resection in 55 high-risk patients, including 30 patients with parenchymal liver disease. Liver volume was expressed as percentage of total liver volume or as standardized future remnant liver volume. Receiver operating characteristic (ROC) curve analysis was performed to identify a cutoff value for future remnant liver function in predicting postoperative liver failure.. Postoperative liver failure occurred in nine patients. A liver function cutoff value of 2.69%/min/m(2) was calculated by ROC curve analysis. (99m)Tc-mebrofenin hepatobiliary scintigraphy demonstrated better sensitivity, specificity, and positive and negative predictive value compared to future remnant liver volume. Using 99mTc-mebrofenin hepatobiliary scintigraphy, one cutoff value suffices in both compromised and noncompromised patients.. Preoperative (99m)Tc-mebrofenin hepatobiliary scintigraphy is a valuable technique to estimate the risk of postoperative liver failure. Especially in patients with uncertain quality of the liver parenchyma, (99m)Tc-mebrofenin HBS proved of more value than CT volumetry.

Topics: Aniline Compounds; Glycine; Hepatectomy; Humans; Imino Acids; Liver; Liver Failure; Organ Size; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals