Current Modalities for the Assessment of Future Remnant Liver Function

Area of Science:

• Hepatology
• Medical Imaging
• Surgical Oncology

Background:

• Volumetric imaging (CT, MRI) offers indirect liver assessment.
• Accurate liver function evaluation is critical for preoperative planning, especially for extensive liver resections and portal vein embolization.
• Existing methods like Child-Pugh and MELD scores provide passive assessment, while indocyanine green (ICG) clearance tests offer dynamic but sometimes inconsistent functional data.

Purpose of the Study:

• To review current modalities for measuring liver function.
• To highlight the advantages of nuclear imaging for simultaneous morphologic and functional assessment.
• To discuss the role of various tests in identifying patients at risk for post-resectional liver failure.

Main Methods:

• Review of passive liver function tests (biochemical parameters, Child-Pugh, MELD scores).
• Analysis of dynamic quantitative tests (e.g., indocyanine green clearance test).
• Evaluation of nuclear imaging techniques (e.g., 99mTc-galactosyl human serum albumin scintigraphy, 99mTc-mebrofenin hepatobiliary scintigraphy).

Main Results:

• Passive tests and clinical scores offer indirect or limited functional insights.
• Dynamic tests like ICG clearance can show discrepancies with clinical outcomes.
• Nuclear imaging provides simultaneous anatomical and functional data, enabling segmental assessment of the future remnant liver.
• Specific nuclear imaging agents can identify patients at risk for liver failure post-resection.

Conclusions:

• No single test comprehensively measures all aspects of liver function.
• Liver functional reserve estimation requires a combination of clinical parameters and quantitative tests.
• Nuclear imaging techniques show promise in improving preoperative risk stratification for liver surgery.