DOI: 10.1186/s13550-016-0248-xPages: 1-8

Hepatobiliary scintigraphy may improve radioembolization treatment planning in HCC patients

1. University Medical Center Utrecht, Department of Radiology and Nuclear Medicine

2. Meander Medical Center, Department of Radiology and Nuclear Medicine

Correspondence to:
Manon N. G. J. A. Braat
Tel: +31 (0) 88 7574881
Email: M.N.G.Braat-3@umcutrecht.nl

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Abstract

Background

Routine work-up for transarterial radioembolization, based on clinical and laboratory parameters, sometimes fails, resulting in severe hepatotoxicity in up to 5% of patients. Quantitative assessment of the pretreatment liver function and its segmental distribution, using hepatobiliary scintigraphy may improve patient selection and treatment planning. A case series will be presented to illustrate the potential of this technique.

Hepatocellular carcinoma patients with cirrhosis (Child-Pugh A and B) underwent hepatobiliary scintigraphy pre- and 3 months post-radioembolization as part of a prospective study protocol, which was prematurely terminated because of limited accrual. Included patients were analysed together with their clinical, laboratory and treatment data.

Results

Pretreatment-corrected 99mTc-mebrofenin liver uptake rates were marginal (1.8–3.0%/min/m2), despite acceptable clinical and laboratory parameters. Posttreatment liver functions seriously declined (corrected 99mTc-mebrofenin liver uptake rates: 0.6–2.4%/min/m2), resulting in lethal radioembolization-induced liver disease in two out of three patients.

Conclusions

Hepatobiliary scintigraphy may be of added value during work-up for radioembolization, to estimate liver function reserve and its segmental distribution, especially in patients with underlying cirrhosis, for whom analysis of clinical and laboratory parameters may not be sufficient.

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  • Accepted: Dec 15, 2016
  • Online: Jan 5, 2017

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