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Case Reports
. 2015 Nov 12;9(3):353-60.
doi: 10.1159/000441385. eCollection 2015 Sep-Dec.

Assessment of Liver Function Using (99m)Tc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

Kasia P Cieslak  1 , Pim B Olthof  1 , Krijn P van Lienden  2 , Marc G Besselink  1 , Olivier R C Busch  1 , Thomas M van Gulik  1 , Roelof J Bennink  3
Affiliations
Case Reports

Assessment of Liver Function Using (99m)Tc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

Kasia P Cieslak et al. Case Rep Gastroenterol. .

Abstract

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a new surgical technique for patients in whom conventional treatment is not feasible due to insufficient future remnant liver (FRL). During the first stage of ALPPS, accelerated hypertrophy of the FRL is induced by ligation of the portal vein and in situ split of the liver. In the second stage, the deportalized liver is removed when the FRL volume has reached ≥25% of total liver volume. However, FRL volume does not necessarily reflect FRL function. (99m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT is a quantitative test enabling regional assessment of parenchymal uptake function using a validated cut-off value for the prediction of postoperative liver failure (2.7%/min/m(2)). This paper describes the changes in FRL function and FRL volume in a 79-year-old patient diagnosed with metachronous colonic liver metastases who underwent ALPPS. We have observed a substantial difference between the increase in FRL volume and FRL function suggesting that HBS with SPECT-CT enables monitoring of the FRL function and could be a useful tool in the timing of resection in the second stage of the ALPPS procedure.

Keywords: 99mTc-mebrofenin hepatobiliary scintigraphy; ALPPS (associating liver partition and portal vein ligation for staged hepatectomy); Monitoring of liver function; Postoperative liver failure.

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Figures

Fig. 1
Fig. 1
Schematic overview of the ALPPS procedure. a Baseline situation with colorectal liver metastases in both hemilivers. b Excision of the metastases in the FRL, ligation of right portal vein and in situ partition of the liver. c Hypertrophy response of the FRL following liver partition. d Situation after the second stage of the procedure in which the deportalized liver has been removed.
Fig. 2
Fig. 2
a CT image after the first stage of the ALPPS procedure showing the in situ transection of the liver according to the planned extended right hemihepatectomy. The right portal vein has been ligated while the right hepatic artery and vein together with the bile system were preserved. b After an interval of 8 days, the resection was completed by removal of segments 4, 5, 6, 7 and 8, leaving segments 1, 2 and 3 as the liver remnant.
Fig. 3
Fig. 3
Summed dynamic HBS with regions of interest (ROIs) drawn around the total liver (red line) and the FRL (segments 1, 2 and 3, white line). Another ROI around the mediastinum (not shown) serves as blood pool. From these ROIs, blood pool corrected time-activity curves can be generated. The uptake rate is subsequently corrected for the patient's metabolic requirements by dividing the uptake rate by the body surface area of the patient. a Baseline situation before the surgical intervention. After the first stage of ALPPS, the FLR uptake rate had increased on POD 3 (b) and 8 (c), owing to the hypertrophy response following the in situ liver transection and ligation of the right portal vein. d After the second stage with completion of the right extended hemihepatectomy, the uptake rate of the FRL had further increased on POD 20.
See this image and copyright information in PMC

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