Radionuclide Hepatobiliary Imaging in Evaluation of Reserved Hepatic Function in Patients with Hepatocelluar Carcinoma before Transcatheter Arterial Embolization

Received 11/26/2003; revised 12/18/2003; accepted 12/26/2003. For correspondence or reprints contact: Dong-Ling You, M.D., Department of Nuclear Medicine, Sun Yat-Sen Cancer Center, Koo Foundation, 125 Lih-Der Rd, Pei-tou District, Taipei 112, Taiwan. Tel: (886)2-28970011, Fax: (886)2-28971314, E-mail: [email protected] Background: Hepatocellular carcinoma (HCC) is a common cancer in Asia. Transcatheter arterial embolization (TAE) is the most common modality to treat unresectable HCC but is contraindicated in patients with insufficient hepatic reserve. The purpose of this study is to use radionuclide hepatobiliary imaging (RHI) to evaluate the reserved hepatic function in patients with HCC before TAE. Methods: Eighty-two patients (male: female = 63:19; age range: 23~72 y/o, mean: 49.6 y/o) with HCC were included in this study. All of the patients underwent conventional hepatic function tests (HFT), and indocyanine green (ICG) test. RHI was done within 2 days after HFT and ICG test. RHI was performed dynamically after bolus injection of 6 mCi of Tc-diisopropyl iminodiacetate (DISIDA) with 60 sec per frame for 60 min. Hepatic extraction fraction (HEF), excretion half-time (T1/2) and peak-time of uptake (PTU) were calculated. The correlations between HEF, T1/2, PTU and HFT, ICG test were studied. Results: There was significant correlation between HEF and Bil, AST, ALT, albumin, Alk-P, PT and ICG test (P <0.05). There was significant correlation between PTU and Bil, Alk-P and ICG test (P <0.05). There was also significant correlation between T1/2 and Bil, Alk-P and ICG test (P <0.05). Discrepancies between HFT and ICG test occurred in 8 patients; however, the values of HEF in these 8 patients correlate well with HFT. Conclusion: RHI could be used as a final arbitration when discrepancy between traditional HFT occurs. HEF could be a single indicator for reserved hepatic function.