Portal uptake function in veno-occlusive regions evaluated by real-time fluorescent imaging using indocyanine green

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• 作者：Yoshikuni Kawaguchi ; Takeaki Ishizawa ; Yoichi Miyata ; Suguru Yamashita ; Koichi Masuda ; Shouichi Satou ; Sumihito Tamura ; Junichi Kaneko ; Yoshihiro Sakamoto ; Taku Aoki ; Kiyoshi Hasegawa ; Yasuhiko Sugawara ; Norihiro Kokudo ; ^{KOKUDO-2SU@h.u-tokyo.ac.jp}
• 关键词：CT ; computed tomography ; ICG ; indocyanine green ; FI ; fluorescence intensity ; RLV ; remnant liver volume ; TLV ; total liver volume ; LV ; liver volume ; LVVO ; liver volume of veno-occlusive regions ; K ; hepatic uptake rate constant ; VO-FRLV ; venous-occlusion-con
• 刊名：Journal of Hepatology
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：58
• 期：2
• 页码：247-253
• 全文大小：993 K

文摘

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Background & Aims

Although recent advances in preoperative imaging have enabled accurate estimation of the regional liver volume with venous occlusion, the extent of functional decrease in such regions remains unclear. In this study, the portal uptake function in postoperative veno-occlusive regions and non-veno-occlusive regions was evaluated by intraoperative fluorescent imaging after intravenous injection of indocyanine green (ICG).

Methods

In 22 liver resection patients and 23 recipients and 18 donors of liver transplantation, fluorescent intensity on the remnant liver or the liver graft was evaluated in real time following intravenous injection of ICG (0.0025 mg per 1 ml of remnant liver volume).

Results

Plateau ICG concentrations were significantly lower in the veno-occlusive regions (C_VO) than in the non-veno-occlusive regions (C_Non) in liver resection patients (median [range], 0.75 [0.29-2.0] ¦Ìg/ml vs. 3.0 [0.46-6.4] ¦Ìg/ml, p <0.001), donors (0.69 [0.29-1.9] ¦Ìg/ml vs. 2.4 [0.46-6.4] ¦Ìg/ml, p <0.001), and recipients (0.75 [0.34-1.8] ¦Ìg/ml vs. 1.8 [0.54-6.4] ¦Ìg/ml, p <0.001). Distributions of the C_VO/C_Non and the ratio of the hepatic uptake rate constant in the veno-occlusive regions to that in non-veno-occlusive regions were both around 40 % (mean ¡À standard deviation, 0.36 ¡À 0.17 and 0.42 ¡À 0.16, respectively). When the functional remnant liver volume was calculated as a sum of non-veno-occlusive regions and veno-occlusive regions multiplied by C_VO/C_Non, its ratio to the total liver volume was correlated with the improved postoperative/preoperative ratio of prothrombin time.

Conclusions

Portal uptake function in veno-occlusive regions is approximately 40 % of that in non-veno-occlusive regions. Intraoperative ICG-fluorescent imaging enables real-time evaluation of the extent of the functional decrease in veno-occlusive regions, enhancing accurate estimation of the hepatic functional reserve for determining the surgical indications and procedures.