SAKAE MATSUZAKI, MASAHIKO ONDA, TAKASHI TAJIRI, AND DEOG Y. KIM mammalian hepatocytes. The indices obtained from Tc-99m We studied the hepatic functional reserve in the lobes GSA planar imaging correlate with conventional indicators of the liver in 28 patients with chronic liver disease and for hepatic functional reserve, eg, serum albumin level, pro-13 controls using single photon emission computed tothrombin time, indocyanine green retention rate at 15 minmography (SPECT) imaging with a radiolabeled asialoutes, indocyanine green disappearance rate, and Pugh modiglycoprotein analog, Technetium-99m-diethylenetrified-Child-Turcotte criteria score (CTCS). aminepentaacetic acid-galactosyl-human serum The purpose of this study was to document changes in the albumin (Tc-99m GSA). Counts of Tc-99m GSA radioachepatic functional reserve of the right and left hepatic lobes tivity in the liver on SPECT images significantly correwith the progression of chronic liver disease, using computed lated (P รต .0001) with the serum albumin level (r ร
tomography (CT) and Tc-99m GSA single photon emission .612), log (serum cholinesterase activity) (r ร
.618), secomputed tomography (SPECT), and to determine whether rum bilirubin level (r ร
.628), prothrombin time (r ร
changes in imaging modalities reflect the hepatic morphologi-.715), hepaplastin test (r ร
.637), and indocyanine cal changes in cirrhosis. green retention rate at 15 minutes (r ร
.771), making it possible to estimate the distribution of functional PATIENTS AND METHODS reserve in the liver based on counts. Using the intact hepatocyte theory, we estimated the number of viable We selected patients and controls from among inpatients and outpatients at Nippon Medical School between January 1993 and Sep-hepatocytes based on the counts. With progression of tember 1996. Subjects were excluded if they had a space-occupying hepatic functional degeneration, counts per unit helesion in the liver on CT images. Patients who had no known history patic volume decreased (r ร
.779, P รต .0001), and left of liver disease and no risk factors for liver disease, but who had lobe to right lobe ratio of this parameter increased (r another unrelated diagnosis were selected as noncirrhotic controls.
ร
.491, P ร
.0019) significantly. These findings suggest All controls were normal on physical examination and results of liver that the reduction of hepatic functional reserve per function tests, including alanine transaminase, aspartate transami- unit hepatic volume and numerical density of the henase, bilirubin, and alkaline phosphatase were normal. The subjects patocytes, and the proliferation of fibrosis in patients included 13 controls (7 men and 6 women; average age, 59 years; with chronic liver disease is slower in the left lobe than range, 36 to 76 years) and 28 patients with chronic liver disease.
The patients with chronic liver disease were diagnosed on the basis of in the right. We discuss a possible biological basis for physical findings, ultrasound findings, CT findings, and biochemical these apparent lobar differences and for hepatic mortests. All patients with chronic liver disease had liver biopsy confirphological changes seen in cirrhosis. (HEPATOLOGY mation of their diagnosis. The controls did not undergo liver biopsy.