Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

This review describes the application of 2 nuclear imaging techniques for assessment of hepatic function in the setting of liver surgery and transplantation. The biochemical and technical background, as well as the clinical applications, of Tc-99m-labeled diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) scintigraphy and hepatobiliary scintigraphy (HBS) with Tc-99m-labeled iminodiacetic acid derivates is discussed. Tc-99m-mebrofenin is considered the most suitable iminodiacetic acid agent for Tc-99m-HBS. Tc-99m-GSA scintigraphy and Tc-99m-mebrofenin HBS are based on 2 different principles. Tc-99m-GSA scintigraphy is a receptor-mediated technique whereas HBS represents hepatic uptake and excretion function. Both techniques are noninvasive and provide visual and quantitative information on both total and regional liver function. They can be used for preoperative assessment of future remnant liver function, follow-up after preoperative portal vein embolization, and evaluation of postoperative liver regeneration. In liver transplantation, these methods are used to assess graft function and biliary complications.