[Visual analysis of hepatic function by a scoring system using 99mTc-GSA]

To establish a simple hepatic function test, a five-point scoring system using 99mTc-galactosyl-human serum albumin (GSA) was applied to seventy-six patients with or suspected with hepatic dysfunction. Dynamic data at rest were obtained immediately and 30 minutes after intravenous bolus injection of 99mTc-GSA (185 MBq). Regions of interest (ROIs) were superimposed over the images of the liver and the entire heart. A visual analysis using a image taken 5 to 6 minutes after radiotracer injection was performed by the three observers blinded to the clinical information to assess their agreement or disagreement on the grading score. kappa-Test was used to evaluate the goodness of agreement. Three pairs in the first reading showed excellent interobserver agreement (0.92 mean kappa-value). Three pairs in the first and second reading also showed excellent intraobserver agreement (0.89 mean kappa-value). Data were also analyzed for correlations with heart/liver count ratio, ICG R15, LHL15, Alb, TB, PT, HPT and ZTT. There were good correlations between visual grading score and ICG R15 (Rs = 0.619, p < 0.0001) and between grading score and heart/liver count ratio (Rs = 0.866, p < 0.0001). Grading score was also correlated with LHL15, Alb, TB, PT, HPT and ZTT (Rs = -0.770; -0.580; 0.593; -0.544; -0.622; 0.518, p < 0.0001 for each). There was a significant difference between heart/liver count ratio and LHL15 in the Grade 4 and Grade 5 groups. In conclusion, the present data suggest that a five-point scoring system based on visual analysis using 99mTc-GSA uptake is a useful indicator for hepatic dysfunction in a clinical setting.