No significant difference was seen in postoperative outcome of these two groups. Thirty-three patients who received neoadjuvant chemotherapy, a cutoff of 1. Overall PVE led to 1. By identifying PVE nonresponder, patients may be considered for associated liver partition and portal vein ligation for staged hepatectomy which has better hypertrophy response. MRI is the investigation of choice for identification and characterization of liver lesion. In hyperbilirubinemic state, renal excretion will be increased further, and its accuracy can be reduced. Liver resection and biliary reconstruction is the only way for a long-term survival in perihilar cholangiocarcinoma PHC.
However, this procedure has a high morbidity and mortality. In a recent study by Olthof et al. They concluded a new FRL-F cutoff of 8. However, all these studies were retrospective in nature, with a small sample size and from single center. A clinical trial comparing the HBS role with liver-specific contrast-enhanced MRI for FRL-V estimation definitely needs attention and action since both have shown a great potential individually. In our experience, we have found that this technique can become a routine NM procedure and can easily be reproduced in any center with a dual head gamma camera; however, SPECT-CT is preferred for more accurate calculations.
We follow a FRL-F cutoff value of 2. Tcm Mebrofenin HBS is a unique procedure for calculation of global and regional liver function. This takes into account the nonuniformity of liver function and underlying liver pathology.
However, further studies will be required to see the impact of hyperbilirubinemia and hypoalbuminemia on its accuracy. Authors would like to acknowledge Dr. Parul Gupta for helping in the final editing of this article. National Center for Biotechnology Information , U. Indian J Nucl Med.
Sherlock's Diseases of the Liver and Biliary System, 13th Edition
Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4. Keywords: Future remnant liver function , gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid magnetic resonance imaging , hepatobiliary scintigraphy , mebrofenin , portal vein embolization , posthepatectomy liver failure.
Introduction Liver resection or transplantation is the only curative way for patients with primary liver malignancies. Open in a separate window. Figure 1. Table 1 Basic advantages and disadvantages of most commonly used test for future remnant liver function estimation and prediction of risk of post hepatectomy liver failure before major liver resection.
Table 2 Acronyms used and their definition. Results HBS is a routine nuclear medicine NM procedure which exploits its tracer functional capabilities with modern day Gamma cameras for direct calculation of global and regional liver function. Technetium m galactosyl human serum albumin scintigraphy GSA binds to asialoglycoprotein receptor present only on mammalian hepatocytes on sinusoidal surface. Pharmacokinetics After injection, IDA binds to protein mainly albumin which minimizes its renal excretion.
Scanning protocol Tcm Mebrofenin scintigraphy for hepatic extraction fraction estimation is simple and can easily be reproduced in any NM center. Box 1. Tcm Mebrofenin scintigraphy protocol for hepatic extraction fraction.
Figure 2. Box 2. Figure 3. Clinical use of Tcm Mebrofenin hepatobiliary scintigraphy in preoperative estimation of future remnant liver function and risk assessment for posthepatectomy liver failure before major liver resection Various clinical studies in the last two decades have shown a notable impact of Tcm Mebrofenin HBS in preoperative workup before major liver resection.
Clinical role of Tcm Mebrofenin hepatobiliary scintigraphy for portal vein embolization stratification before major liver resection PVE is a well-accepted procedure to increase the FRL-F before major liver resection. Clinical role of Tcm Mebrofenin hepatobiliary scintigraphy in perihilar cholangiocarcinoma before major liver resection Liver resection and biliary reconstruction is the only way for a long-term survival in perihilar cholangiocarcinoma PHC.
Conclusion Tcm Mebrofenin HBS is a unique procedure for calculation of global and regional liver function.
Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgment Authors would like to acknowledge Dr. References 1. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. Liver failure after partial hepatic resection: Definition, pathophysiology, risk factors and treatment.
Liver Int. Kauffmann R, Fong Y. Post-hepatectomy liver failure.
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Student View Student Companion Site. About the Author James S. Anna S. Permissions Request permission to reuse content from this site. Anatomy and Function 1 Jay H. Tujios and William M. Bansal and Scott L.
Kelly Investigation of liver disease in children Neonatal jaundice Neonatal unconjugated hyperbilirubinaemia Neonatal liver disease conjugated hyperbilirubinaemia Neonatal hepatitis Inherited disease in the neonate Genetic cholestatic syndromes Structural abnormalities: biliary atresia and choledochal cyst Acute liver failure in infancy Liver disease in older children Metabolic disease in older children Cirrhosis and portal hypertension Liver transplantation Tumours of the liver References 32 The Liver in Systemic Diseases James S.
Wanless Diagnosis of focal liver lesions Hepatocellular lesions Biliary and cystic lesions Mesenchymal tumours References 36 Primary Malignant Neoplasms of the Liver Adam Doyle and Morris Sherman Hepatocellular carcinoma Intrahepatic cholangiocarcinoma Other malignant neoplasms of the liver Other sarcomas References 37 Hepatic Transplantation Lindsay Y. King and Carl L. Seller Inventory GRP More information about this seller Contact this seller 2.
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