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Hepatobiliary scintigraphy for risk assessment of posthepatctomy liver failure

Aim: to assess the role of hepatobiliary scintigraphy for prognosis of hepatic failure after liver resection; to determine threshold index of hepatic uptake of radioactive agent as an indication for surgical prevention of hepatic failure. Material and Methods. The study included 2 groups of patients who underwent hepatobiliary scintigraphy. The 1st group consisted of 50 patients with diffuse liver diseases (chronic hepatitis, liver cirrhosis) in whom histological examination of liver was performed according to METAVIR. 49 patients with liver tumors underwent advanced liver resections (over segments by Couinaud). Results. The highest median of hepatic uptake (2,86) was revealed in patients with liver fibrosis F1, the lowest (2,02) – in patients with liver fibrosis F4. Threshold value of hepatic uptake was 2,4. In 18 patients with hepatic uptake index <2,4 and remnant liver <40% surgical prevention of hepatic failure was performed: portal vein ligation (1), portal embolization (12), percutaneous embolization with radiofrequency ablation along the plane of future liver dissection (5). An increase of hepatic uptake index up to 2.7 ± 0.47 was revealed in the areas of liver regeneration and hypertrophy in 14–21 days after surgery. Conclusion. Combined static and dynamic hepatobiliary scintigraphy is valuable to assess volume and function of different liver segments. Threshold hepatic uptake index of 2.4 is sensitive to predict postoperative liver failure in case of future remnant liver <40%.