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INTRODUCTION review board; informed consent was obtained from
all patients before 99m Tc-GSA scintigraphy and CT. We
In liver surgery, preoperative treatment planning is retrospectively reviewed patients who had undergone
defined in the context of the anatomical structure and liver surgery between July 2014 and August 2015 in the
the functional reserve of the liver. In patients who have Department of Surgery of our hospital. Twenty-five patients
damaged liver function or who are scheduled to undergo preoperatively underwent 3D- 99m Tc-GSA scintigraphy/
extended hepatectomy, the postoperative residual liver vascular fused imaging using SYNAPSE VINCENT.
volume with adequate preservation of blood supply and
drainage vessels is very important for the prevention of The following exclusion criteria were applied: (1) a
liver failure. [1] history of hepatectomy or portal embolization; (2) hilar
cholangiocarcinoma with unilateral biliary drainage; and
Virtual reality simulation on computed tomography (CT), (3) hepatectomy for benign disease. A total of 15 patients
magnetic resonance imaging (MRI), or ultrasonography (10 men and 5 women; age, 60 to 81 years; mean, 72.7
(US) plays an important role in examining the anatomical years) who agreed to undergo preoperative 3D- 99m Tc-GSA
structure of the liver. Recently 3-dimensional (3D) imaging scintigraphy/vascular imaging using SYNAPSE VINCENT
techniques, such as 3D CT, 3D MRI, and 3D US, have been were studied. The diagnosis was hepatocellular carcinoma
developed. To date, a number of methods and software in 4 patients, metastatic liver tumor in 10 patients, and
systems have been developed for 3D surgical planning intrahepatic cholangiocarcinoma in 1 patient. Based on the
before liver surgery. [2-6] Remnant liver volume can thus be [17]
determined (volumetry) before hepatectomy. Brisbane 2000 classification criteria, right hepatectomy
was performed in 2 patients, left hepatectomy in 3
Technetium-99m-diethylenetriaminepentaacetic acid- patients, right posterior sectionectomy in 3 patients,
galactosyl-human serum albumin ( 99m Tc-GSA) is an analog segmentectomy in 2 patients, and partial hepatectomy in
ligand of asialoglycoprotein. 99m Tc-GSA binds to the 5 patients. Background of the liver was liver cirrhosis in 2
asialoglycoprotein receptor (ASGP-R) located specifically patients, chronic hepatitis in 1 patient, and normal liver
on hepatocytes. The ASGP-Rconcentration is helpful in in 12 patients. The planned resection region of the liver
evaluating the extent and progression of liver disease, could be similarly resected in all patients.
so the hepatic uptake of 99m Tc-GSA reflects the number
of functioning hepatocytes. [7-11] Before hepatic resection, 3D-vascular imaging using SYNAPSE VINCENT
however, it is difficult to correctly estimate the functional Preoperative enhanced CT was performed with a
hepatocyte mass of the remnant liver. 64-multidetector-row CT scanner (Discovery CT 750
HD, GE Healthcare Japan, Co. Ltd., Tokyo, Japan) at
Thus, 99m Tc-GSA scintigraphy combined with single-photo 0.625-mm intervals. Four-phase contrast-enhanced CT
emission computerized tomography (SPECT) and CT fused was performed 30, 60, 90, and 180 s after initiating the
imaging has been used to estimate the future remnant injection of contrast media to obtain hepatic arterial,
liver function before hepatic resection. [12-16] However, the portal venous, hepatic venous, and equilibrium phase
planned resection region had to be set manually using a images, respectively. A total of 100 mL of nonionic
2-dimensional CT display. It was difficult to estimate the contrast material containing 370 mg of iodine per milliliter
local remnant liver function in detail.
(Iopamidol, Bayer Yakuhin, Osaka, Japan) was injected
intravenously at a rate of 3.3 mL/s using an automatic
The volume analyzer software SYNAPSE VINCENT (Fujifilm
Medical Co., Tokyo, Japan) is a high-speed 3D image power injector. With the use of a workstation, a routine
analysis system. Using previously captured CT or MRI, preoperative CT workup was performed in the axial and
high-definition 3D images of organs and vessels can be coronal imaging planes. The data were obtained in Digital
reconstructed quickly. It has become easy to grasp the Imaging and Communications in Medicine format and
[4]
complex anatomical relations between the portal triad, transmitted to a workstation running SYNAPSE VINCENT.
hepatic veins, and local tumor by volume rendering. With
this software, the surgeon can simulate various patterns Liver Analysis Application uses Dynamic-CT imaging of the
of planned hepatectomy. [4-6] liver. After data for the hepatic arterial, portal venous, and
hepatic venous phases are obtained, operative simulation
In the present study, we performed preoperative liver by 3D-vascular images is performed. After selection of
functional volumetry by 3D- 99m Tc-GSA scintigraphy/ the portal venous branch of the planned resection area,
vascular fused imaging using SYNAPSE VINCENT and surgical simulations can be displayed. This system also
examined the discrepancy between conventional and can calculate the total liver volume, tumor volume, and
functional volumetry. volume of planned resection region. [4]

METHODS 99m Tc-GSA scintigraphy
99m
A bolus of 1 mL of Tc-GSA (185 MBq, Nihon Medi-physics
This retrospective study was approved by our institutional Co. Ltd., Nishinomiya, Japan) was intravenously injected
188 Hepatoma Research | Volume 2 | July 1, 2016