ASO Author Reflections: Usage of Single Photon Emission CT (SPECT) Hepatobiliary Scintigraphy to Detect the Impact of Chemotherapy-Associated Liver Injuries (CALI) on Liver Function Before a Major Hepatectomy

Excerpt

Preoperative chemotherapy is indicated in many patients before resection with curative intent of primary or secondary malignant liver tumors, in particular colorectal liver metastases deemed potentially resectable. This therapeutic strategy entails the risk of significant chemotherapy-associated liver injuries (CALI), mainly steatosis, sinusoidal obstruction syndrome (SOS), or steatohepatitis graded according to the NAS score. Patients with CALI are difficult to identify as displaying mostly normal liver function tests, while being at higher risk of liver failure and morbi-mortality after major hepatectomy (especially for steatohepatitis1). So far, the preoperative workup has consisted in liver volumetry by computed tomography (CT) with a cutoff of minimum remnant liver volume tolerable of 30–40% of total liver volume in such patients. Global liver function tests (e.g., ICG-R15) or liver biopsies are limited by heterogeneously distributed CALI. Screening for indirect signs of CALI, such as APRI,2 thrombocytopenia, and/or splenomegaly,3 could work. Recently, hepatobiliary scintigraphy (HBS) using (99m)Tc-Iminodiacetic Acid compounds (mebrofenin) with SPECT has allowed assessing segmental liver function. This study assessed SPECT–HBS as a method for evaluating CALI preoperatively. …