Radionuclide Hepatobiliary Imaging in Evaluation of Reserved Hepatic Function in Patients with Hepatocelluar Carcinoma before Transcatheter Arterial Embolization

背景：肝細胞癌在亞洲是一種常見之惡性腫瘤。對於無法以手術切除之肝細胞癌，肝動脈栓塞是最常使用的一種治療方式，然而卻不適用於肝功能不足之病人。本研究之目的是使用同位素肝膽道攝影來評估接受肝動脈栓塞治療前肝癌病人之貯備肝功能。方法：本研究共包含了82位病人，其中男性63人，女性19人，年龄介於23～72歲，平均年龄49.6歲。所有的病人均接受傳統肝功能檢查包括血清膽紅素、麩胺酸草醋酸轉胺酵素、麩胺酸焦葡萄糖酸轉胺酵素、白蛋白、鹼性磷酸鹽酵素、與前凝血酵素時間，以及靛青藍綠染料試驗。病人於上述檢查完成後二日内接受同位素肝膽道攝影。我們計算同位素肝膽道攝影中之肝攝取率(hepatic extraction fraction)、排除半衰期(excretion half-time)以及攝取高峰時間(peak-time of uptake)，並統計其與傳統肝功能檢查以及靛青藍綠染料試驗之間的相關性。結果：研究結果顯示肝攝取率與總膽紅素、麩胺酸草醋酸轉胺酵素、麩胺酸焦葡萄糖酸轉胺酵素、白蛋白、鹼性磷酸鹽酵素、前凝血酵素時間，以及靛青藍綠染料試驗呈現有意義的相關性：藥物排除半衰期以及攝取高峰時間也與總膽紅素、鹼性磷酸鹽酵素、靛青藍綠染料試驗呈現有意義的相關性。結論：肝膽道攝影檢查可於傳統肝功能檢查以及靛青藍綠染料試驗結果相悖時做為仲裁，肝攝取率是其中最具效益之参考値。

關鍵字

肝細胞癌；肝動脈栓塞；肝膽道攝影

並列摘要

Background: Hepatocellular carcinoma(HCC)is a common cancer in Asia. Transcatheter arterial embolization(TAE)is the most common modality to treat unresectable HCC but is contraindicated inpatients with insufficient hepatic reserve. The purpose of this study is to use radionuclide hepatobiliary imaging (RHI)to evaluate the reserved hepatic function inpatients with HCC before TAE. Methods: Eighty-two patients(male: female=63:19;age range:23～72 y/o,mean:49.6 y/o)with HCC were included in this study. All of the patients underwent conventional hepatic function tests(HFT),and indocyanine green(ICG)test. RHI was done within 2 days after HFT and ICG test. RHI was performed dynamically after bolus injection of 6 mCi of 99mTc-diisopropyl iminodiacetate (DISIDA)with 60 sec per frame for 60 min. Hepatic extraction fraction(HEF),excretion half-time(T(subscript 1/2))and peak-time of uptake(PTU)were calculated. The correlations between HEF,T(subscript 1/2),PTU and HFT, ICGtest were studied. Results: There was significant correlation between HEF and Bil, AST,ALT, albumin, Alk-P,PT and ICG test(P＜0.05).There was significant correlation between PTU and Bil, Alk-P and ICG test(P＜0.05).There was also significant correlation between T(subscript 1/2)and Bil, Alk-Pand ICG test(P＜0.05).Discrepancies between HFT and ICG test occurred in 8 patients; however, the values of HEF in these 8 patients correlate well with HFT. Conclusion: RHI could be used as a final arbitration when discrepancy between traditional HFT occurs. HEF could be a single indicator for reserved hepatic function.

並列關鍵字

hepatocellular carcinoma ； transcatheter arterial embolization ； hepatobiliary imaging

國際替代計量

Radionuclide Hepatobiliary Imaging in Evaluation of Reserved Hepatic Function in Patients with Hepatocelluar Carcinoma before Transcatheter Arterial Embolization

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