| Background:Assessment of hepatic functional reserve, especially the remnant functional reserve, is always a critically important problem in liver surgery. During the recent years, as a receptor im-aging agent with high specialty, the value of galactosyl human serum albumin (GSA) receives more and more attention. The advantage of 99mTc-GSA scintigraphy includes that using it func-tional hepatic cell volume can be evaluated, regional liver function can be assessed and it is not affected by serum bilirubin. In spite of many articles focus on the area of hepatic cirrhosis and hepatic cell carcinoma (HCC), there is no clinical study in obstructive jaundice especially with large sample. Also, there are few studies concerning about evaluation of functional reserve before major resection using 99mTc-GSA scintigraphy.Objectives:1. To evaluate the total and regional hepatic function of normal liver and damaged liver.2. To analyze the influence of the unilateral decrease of portal venous flow and/or the laterality of biliary dilation to the regional hepatic function.3. To study the predictive value of the Tc-GSA scintigraphy index for the postoperative liver dysfunction.4. To observe the speed of functional liver regeneration after major resection and LDLT.Methods:Between January 2010 and December 2010, Tc-GSA studies were performed in patients who were supposed to undergo hepatectomy at PLA General Hospital. The diseases include HCC with liver cirrhosis, hilar cholangiocarcinoma with obstructive jaundice, congenital biliary cyst, hepatolithiasis and other tumors. Three donors were also enrolled. Besides the normal liver fictional tests and ICG test (the latter is not for patients with jaundice), the patients received CT scan and dynamic SPECT scan in turn using SPECT/CT of Simens Symbia T6, and a series of index were calculated including CT-FV, CT-RR, GSA-FV, GSA-K etc. The patients are grouped as liver cirrhosis group, hilar occupying lesion group, major resection for HCa group, major resection group and post-hepatectomy group and the corresponding analysis were performed.Results:99mTc-GSA studies were performed in 122 patients and 127 person-trips. The number of male and female was 75 and 42, respectively. The age was 51.9±11.6y (20-76y). In the liver cirrhosis group, with respect to Child-Pugh score, the number of patients of Child A, B, C classification was 44,10 and 1, respectively. There are significant relation between GSA-K and CP score (r=-0.423, P=0.001), ICG-K (r=0.730, P=0.000),GSA-FV/CT-FV (r=0.275, P=0.042), T-Bil (r=-0.304, P=0.024), PT(r=-0.298, P=0.029). Meanwhile, patients with CTP A are found to have a wide variety of liver functional reserves when assessed using GSA-K, just as that using ICG-K. If the left or right branch of portal vein was involved and the venous flow decreased, the functional resection ratios calculated by GSA is lower than the ana-tomic resection ratios by CT (P=0.000).There were 36 patients in the hilar occupying lesion group and 32 patients were with obstructive jaundice. There was no correlation between the value of GSA-K and the value of T-Bil. Similarly, if the main trunk of portal vein was involved, the functional resection ratios were lower than the anatomic resection ratios in this group.Fifty-eight patients were performed hepatectomy and the sign of dysfunction emerged in eight patients, and the patients were divided into two groups accordingly. After univariate analy-ses and multivariate analyses, we found GSA-RR useful in preoperative prediction of post-hepatectomy liver dysfunction (Exp (B)=1.106, P=0.02). The same result was found in the major resection for HCa group.Postoperative liver regeneration was also studied. The increment of morphological volume by CT was more than the increment of functional volume by GSA scintigraphy in the five cases.Conclusion:Using 99mTc-GSA SPECT/CT Scintigraphy, hepatic functional reserve can be evaluated effectively, no matter the liver is with cirrhosis or cholestasis. Comparing with CT, 99mTc-GSA SPECT/CT can evaluate the regional liver function more accurately and the related index can be used to help with the detailed assessment of liver reserve for patients with liver cirrhosis. They are useful in prediction of the post-operative liver dysfunction.
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