99m Tc-mebrofenin hepatobiliary scintigraphy and volume metrics before liver preparation: correlations and discrepancies in non-cirrhotic patients.

Background: Accurate identification of insufficient future liver remnant (FLR) is required to select patients for liver preparation and limit the risk of post-hepatectomy liver failure (PHLF). The objective of this study was to investigate the correlations and discrepancies between the most-commonly used FLR volume metrics and ^99m Tc-mebrofenin hepatobiliary scintigraphy (HBS).
Methods: In 101 non-cirrhotic patients who underwent HBS before major hepatectomy, we retrospectively analyzed the correlations and discrepancies between FLR function and FLR volume metrics: actual percentage (FLRV%), standardized to body surface area (FLRV% ^BSA ) and weight (FLRV% ^weight ), and FLR to body weight ratio (FLRV-BWR).
Results: Among 67 patients with FLR function ≥2.69%/min/m ² , PHLF was observed in none and 13 patients according to respectively 50-50 and ISGLS criteria. FLRV%, FLRV% ^BSA , FLRV% ^weight and FLRV-BWR significantly correlated with FLR function (P<0.001), with Spearman's correlation coefficients of 0.680, 0.704, 0.698, and 0.711, respectively. No difference was observed between the areas under the curve of FLRV%, FLRV% ^BSA , FLRV% ^weight and FLR-BWR (all P=ns). Overall, the percentages of patients misclassified by FLRV%, FLRV% ^BSA , FLRV% ^weight (thresholds: 30%) and FLR-BWR (threshold: 0.5) versus FLR function (threshold: 2.69%/min/m ² ) were 23.8% (95% CI: 15.9-33.3%), 18.8% (95% CI: 11.7-27.8%), 17.8% (95% CI: 11-26.7%), and 31.7% (95% CI: 22.8-41.7%), respectively. FLR volume metrics wrongly classified 1-13.9% of patients with sufficient FLR function (i.e., ≥2.69%/min/m ² ), and 9.9-30.7% of patients with insufficient FLR function. FLRV-BWR was the most and the least reliable measure to identify patients with sufficient and insufficient FLR function, respectively.
Conclusions: Despite significant correlations, the discrepancy rates between FLR volume and function metrics speaks in favor of implementing ^99m Tc-mebrofenin HBS in the work-up before liver preparation.
Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (http://dx.doi.org/10.21037/atm-20-7372). The authors have no conflicts of interest to declare.
(2021 Annals of Translational Medicine. All rights reserved.)