and YASUO KAMIYAMA 1 differences are thought to depend mainly on the effective Technetium-99m-diethylenetriaminepentaacetic acidhepatic blood flow and the intra-, extrahepatic shunt.
galactosyl human serum albumin (Tc-GSA) is a new liver
Ashwell and Morell demonstrated the existence of a hepatic scintigraphy agent which binds to the asialoglycoprobinding receptor for asialoglycoproteins (ASGP) with the intein receptors. We evaluated the preoperative assessvestigation of ceruloplasmin metabolism. 6 They found that ment for hepatectomy using Tc-GSA liver scintigraphy.
ceruloplasmin molecules, which lack a sialic acid residue, Ninety patients with hepatocellular carcinoma were adrapidly disappeared from the circulation and were taken up mitted for elective hepatectomy. Tc-GSA scintigraphy by hepatocytes. 7 This activity was found to be exclusively was conducted after the intravenous injection of Tcassociated with a protein termed ASGP receptors (ASGPR) GSA, and maximal removal rate of Tc-GSA (GSA-Rmax)
in the sinusoidal membrane of hepatocytes. 8 Sawamura et was calculated using a radiopharmacokinetic model.
al. 9 reported that a decrease in the number of ASGPRs led Measurement of GSA-Rmax, conventional liver function, to the accumulation of ASGP in the sera of galactosamineand 15-minute retention rate of indocyanine green treated rats. In addition, this receptor decreases in patients (ICGR15) was carried out preoperatively. The relationwith chronic liver disease. 10 ships between liver functions, histological activity index Technetium-99m-diethylenetriaminepentaacetic acid-ga-(HAI), ICGR15, and GSA-Rmax values were estimated. A lactosyl, human serum albumin (Tc-GSA), is a new liver scinsignificant correlation was obtained between GSA-Rmax tigraphy agent which binds to the ASGPR on hepatocytes. and ICGR15 (r Å .534, P õ .0001). Preoperative discrepan-Maximal removal rate of Tc-GSA (GSA-Rmax) using a radiocies between GSA-Rmax and ICGR15 values were seen pharmacokinetic model decreased with the severity of liver in 15 patients. In these cases, the GSA-Rmax values cordisease, and there was also a significant difference in the related well with the total HAI scores (r Å .595, P õ .02), GSA-Rmax between the chronic hepatitis and normal liver but no significant correlation was seen between the groups. 11 The purpose of this study was to evaluate the clini-ICGR15 and HAI scores. Two patients died of postoperacal utility of the GSA-Rmax for the preoperative assessment tive liver failure within 2 months of the operation. These of hepatectomy in patients with hepatocellular carcinoma. two patients were found to have severe discrepancies between their preoperative GSA-Rmax and ICGR15 val-PATIENTS AND METHODS ues. We concluded that GSA-Rmax might be useful for selecting candidates for hepatectomy and that extended Clinical Material hepatectomies (di-and tri-segmentectomy) are high-risk Ninety patients with hepatocellular carcinoma were admitted to surgical procedures in the case of low GSA-Rmax scores Kansai Medical University for elective hepatectomy between October (below 0.35). (HEPATOLOGY 1997;25:426-429.) 1992 and December 1995. The mean age of all patients was 61 years, with a range of 43 to 77 years. There were 72 (80%) male and 18 (20%) female patients, yielding a male:female ratio of 4:1; 59 patients Abbreviations: ICG, indocyanine green clearance; ASGP, asialoglycoproteins; ASGPR, asialoglycoprotein receptors; Tc-GSA, Technetium-99m-diethylenetriaminepentaacetic the radiopharmacokinetic model described previously. 11 acid-galactosyl human serum albumin; Rmax, maximal removal rate; ICGR15, 15-minute The general structure of the model was composed of five compartretention rate of indocyanine green clearance; HAI, histological activity index. ments for describing Tc-GSA which are: 1) extrahepatic blood; 2)
From the 1 First Department of Surgery and the 2 Department of Radiology, Kansai Medihepatic blood; 3) hepatocytes; 4) interstitial fluid; and 5) urine (Fig.