Quantitative assessment of liver function using hepatobiliary scintigraphy

This thesis provides an overview on the quantification of liver function and its several potential applications in various clinical settings. Patients undergoing major liver resection are at risk of developing posthepatectomy liver failure. Therefore, preoperative assessment of the future remnant liver (FRL) function is important. Technetium-99m mebrofenin hepatobiliary scintigraphy (HBS) is an inexpensive and non-invasive dynamic quantitative liver function test. It combines functional and anatomic information, allowing measurement of total and regional liver function. Traditionally, preoperative assessment of the FRL was done using CT-volumetry. However, liver volume does not always correlate with liver function and liver function is not always homogeneously distributed in the liver.
Liver augmenting techniques like portal vein embolization can be applied preoperatively to increase the function and volume of the FRL. There is a discrepancy between the increase in volume and function, further emphasizing the significance of functional assessment. HBS can hereby aid in the monitoring of the hypertrophy response and optimal timing to resection.
The liver has a unique capacity to regenerate after resection in order to restore the functional mass. This predominantly occurs in the first days after resection which is impaired in case of severe complications. There seems to be a discrepancy with the increase in volume which gradually takes place during the first weeks. HBS might aid in early detection of patients at risk of developing liver failure after resection.