99mTc GSA scintigraphy predicts post-hepatectomy liver failure in biliary tract cancer

Technetium-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy is a useful method for assessing liver function and its heterogeneity. We evaluated its predictive usefulness for post-hepatectomy liver failure (PHLF) in liver resection for biliary tract cancer.

Between 2013 and 2024, 95 patients underwent major hepatectomy with bile duct resection for biliary tract cancer and had preoperative 99mTc-GSA scintigraphy. The GSA-K value was defined using established reduction formulas of indocyanine green plasma clearance rate (ICG-K) values based on LHL15 value (99mTc-GSA uptake ratio of the liver to the liver plus heart at 15 min) from 99mTc-GSA scintigraphy. Functional remnant liver volume (f-RLV) ratio was estimated by dividing scintillation counts of the future remnant liver by total counts of the whole liver. We compared volumetric (ICG-Krem: ICG-K x RLV ratio) and functional (GSA-Krem: GSA-K x f-RLV ratio) assessment methods of the future remnant liver for predicting PHLF.

PHLF was observed in 34 patients (35.8%) and a receiver operating characteristic curve revealed cut-off values for predicting PHLF of 0.088 for ICG-Krem and 0.086 for GSA-Krem. Positive predictive values for PHLF were 53.2% (ICG-Krem) and 87.6% (GSA-Krem). In patients with portal vein embolization (PVE), GSA-Krem showed 89.1% of positive predictive value for PHLF, and ICG-Krem was very low (53.3%). The multivariate analysis identified GSA-Krem as one of independent predictors of PHLF.

GSA-Krem derived from 99mTc-GSA scintigraphy is a valuable predictor of PHLF.