Vol 24, No 1 (2021)
Research paper
Published online: 2021-01-31

open access

Page views 993
Article views/downloads 813
Get Citation

Connect on Social Media

Connect on Social Media

Effect of position and volume of spaceoccupying liver lesions on liver function index in 99mTc-GSA scintigraphy

Ryotaro Tokorodani1, Hiromitsu Daisaki2, Okada Yukinori3, Yasuda Eisuke4
Pubmed: 33576478
Nucl. Med. Rev 2021;24(1):1-10.


Background: The authors aimed to elucidate the effect of liver space-occupying lesions (SOL) on the quantitative index of the hepatic reserve, calculated using the dynamic planar image (LHLplanar), and a three-dimensional quantitative index (LHLSPECT) calculated using quantitative combined modality single-photon emission computed tomography (SPECT/CT). Material and Methods: Water balloons of different volumes that simulated liver SOL were placed in various positions in the combined cardiac-liver phantom to examine the effects of liver SOL on visualization and quantitative indicators (LHLplanar and LHLSPECT). A 200 mL water balloon was placed in the anterior right, posterior right, left medial and left lateral lobes in the liver phantom to compare LHLplanar and LHLSPECT values with and without liver SOL at each position. Subsequently, volumes of those in the front of the right lobe were changed to 50 mL, 100 mL, 200 mL, and 400 mL, followed by statistically comparing LHLplanar and LHLSPECT values in the presence and absence of liver SOL. Results: Despite the variation in the degree of defect accumulation with the location of the balloon when using frontal planar imaging, quantitative SPECT/CT imaging identified all defects. Multiple comparison analysis revealed that unlike LHLSPECT, the LHLplanar values changed according to liver SOL position and volume. Conclusions: Liver SOL position and volume may affect the hepatic reserve assessments performed using LHLplanar values. In contrast, LHLSPECT is calculated using quantitative SPECT/CT and considers the effects of scattering and attenuation corrections. Therefore, LHLSPECT is a more accurate quantitative indicator of hepatic reserve than LHLplanar and is expected to facilitate future clinical research.

Article available in PDF format

View PDF Download PDF file


  1. Farges O, Malassagne B, Flejou JF, et al. Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg. 1999; 229(2): 210–215.
  2. Nagasue N, Kohno H, Chang YC, et al. Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg. 1993; 217(4): 375–384.
  3. Scheele J, Stangl R, Altendorf-Hofmann A, et al. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery. 1991; 110(1): 13–29.
  4. Morell AG, Gregoriadis G, Scheinberg IH, et al. The role of sialic acid in determining the survival of glycoproteins in the circulation. J Biol Chem. 1971; 246(5): 1461–1467.
  5. Orita Y, Onodera A, Natsume T. Devised a New Preoperative Simulation Using 99mTc-GSA SPECT Quantitative Method for Liver Resection. Japanese Journal of Radiological Technology. 2016; 72(1): 50–57.
  6. Okabe H, Beppu T, Hayashi H, et al. Rank classification based on the combination of indocyanine green retention rate at 15 min and (99m)Tc-DTPA-galactosyl human serum albumin scintigraphy predicts the safety of hepatic resection. Nucl Med Commun. 2014; 35(5): 478–483.
  7. Iimuro Y, Kashiwagi T, Yamanaka J, et al. Preoperative estimation of asialoglycoprotein receptor expression in the remnant liver from CT/99mTc-GSA SPECT fusion images correlates well with postoperative liver function parameters. J Hepatobiliary Pancreat Sci. 2010; 17(5): 673–681.
  8. Yoshida M, Shiraishi S, Sakaguchi F, et al. A quantitative index measured on 99mTc GSA SPECT/CT 3D fused images to evaluate severe fibrosis in patients with chronic liver disease. Japanese Journal of Radiology. 2012; 30(5): 435–441.
  9. Shuke N, Okizaki A, Kino S, et al. Functional mapping of regional liver asialoglycoprotein receptor amount from single blood sample and SPECT. J Nucl Med. 2003; 44(3): 475–482.
  10. Kaibori M, Ha-Kawa SK, Ishizaki M, et al. HA/GSA-Rmax ratio as a predictor of postoperative liver failure. World J Surg. 2008; 32(11): 2410–2418.
  11. Miki K, Kubota K, Kokudo N, et al. Asialoglycoprotein receptor and hepatic blood flow using technetium-99m-DTPA-galactosyl human serum albumin. J Nucl Med. 1997; 38(11): 1798–1807.
  12. Morikatsu Y, Toru B, Shinya S, et al. Noriko, 99mTc-GSA SPECT/CT fused images for assessment of hepatic function and hepatectomy planning. Ann Transl Med. 2015; 3: 17.
  13. Tokorodani R, Sumiyoshi T, Okabayashi T, et al. Liver fibrosis assessment using 99mTc-GSA SPECT/CT fusion imaging. Jpn J Radiol. 2019; 37(4): 315–320.
  14. Matumoto T, Iinuma TA, Ishikawa T, et al. [SOL-detectability of liver SPECT--analysis of the structure of ROC-curve]. Radioisotopes. 1985; 34(9): 486–492.
  15. Mori Y, Kawakami K, Machida K, et al. A cooperative group study of clinical efficacy of the liver SPECT. Radioisotopes. 1987; 36(9): 457–464.
  16. Zeintl J, Vija AH, Yahil A, et al. Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximization with 3-dimensional resolution recovery, attenuation, and scatter correction. J Nucl Med. 2010; 51(6): 921–928.
  17. Nakahara T, Daisaki H, Yamamoto Y, et al. Use of a digital phantom developed by QIBA for harmonizing SUVs obtained from the state-of-the-art SPECT/CT systems: a multicenter study. EJNMMI Res. 2017; 7(1): 53.
  18. Tokorodani R, Ueta K, Kume T, et al. Evaluation of Normal Bone Standardized Uptake Values Using Quantitative SPECT with Improved Spatial Resolution. Kakuigaku gijyutu. 2017(3): 201–210.
  19. Hasegawa D, Onishi H. Evaluation of Accuracy for Quantitative Predictor of Hepatic Functional Reserve Using Planar and SPECT Images in the Tc-GSA Scintigraphy. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2017; 73(10): 1055–1060.
  20. de Dr, Strijckmans V, Almeida P, et al. Boneequivalent liquid solution to asses accuracy of transmission measurements in SPECT and PET. IEEE Trans Nucl Sci. 1997; 44: 1186–90.
  21. Torizuka K, Ha-Kawa SK, Kudo M, et al. Phase III multi-center clinical study on 99mTc-GSA, a new agent for functional imaging of the liver. Kaku Igaku. 1992(29): 159–181.
  22. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476): 307–310.
  23. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013; 48(3): 452–458.
  24. Imaeda T, Kanematsu M, Asada S, et al. Utility of Tc-99m GSA SPECT imaging in estimation of functional volume of liver segments in health and liver diseases. Clin Nucl Med. 1995; 20(4): 322–328.
  25. Kotani K, Kawabe J, Higashiyama S, et al. Heterogeneous liver uptake of Tc-99m-GSA as quantified through SPECT/CT helps to evaluate the degree of liver fibrosis: A retrospective observational study. Medicine (Baltimore). 2018; 97(31): e11765.