Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer: An appraisal using 99mTc-GSA SPECT/CT fusion imaging

摘要

Purpose: To determine the functional discrepancy between the two liver lobes using technetium 99m (99mTc) diethylenetriamine- pentaacetic acid-galactosyl human serum albumin (GSA) single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging following preoperative biliary drainage and portal vein embolization (PVE) in patients with jaundice who have bile duct cancer (BDC).Materials and Methods: This retrospective study was approved by the institutional review board, with waiver of informed consent. Preoperative 99mTc-GSA SPECT/CT fusion images from 32 patients with extrahepatic BDC were retrospectively reviewed. Patients were classified into four groups according to the extent of biliary drainage and presence of a preoperative right PVE: right lobe drainage group (right drainage), bilateral lobe drainage group (bilateral drainage), left lobe drainage group (left drainage), and left lobe drainage with right PVE group (left drainage with right PVE). Percentage volume and percentage function were measured in each lobe using fusion imaging. The ratio between percentage function and percentage volume (the function-to-volume ratio) was calculated for each lobe, and the results were compared among the four groups. Statistical analysis was performed with Wilcoxon signed-rank tests and Mann- Whitney U tests.Results: The median values for the function-to-volume ratio in the right drainage, bilateral drainage, left drainage, and left drainage with right PVE group were 1.12, 1.05, 1.02, and 0.81 in the right lobe; and 0.51, 0.88, 0.96, and 1.17 in the left lobe. Significant differences in the function-tovolume ratio were observed among the four groups (right drainage vs bilateral drainage vs left drainage vs left drainage with right PVE; with P < .002, P = .023, and P < .002 for the right lobe and P < .001, P = .023, and P < .002 for the left lobe).Conclusion: Hepatic lobar function significantly differs between the two lobes, depending on the extent of biliary drainage and the presence of portal vein embolization.