Hepatobiliary scintigraphy may improve radioembolization treatment planning in HCC patients

Background: Routine work-up for transarterial radioembolization, based on clinical and laboratory parameters, sometimes fails, resulting in severe hepatotoxicity in up to 5% of patients. Quantitative assessment of the pretreatment liver function and its segmental distribution, using hepatobiliary scintigraphy may improve patient selection and treatment planning. A case series will be presented to illustrate the potential of this technique. Hepatocellular carcinoma patients with cirrhosis (Child-Pugh A and B) underwent hepatobiliary scintigraphy pre- and 3 months post-radioembolization as part of a prospective study protocol, which was prematurely terminated because of limited accrual. Included patients were analysed together with their clinical, laboratory and treatment data. Results: Pretreatment-corrected Tc-99m-mebrofenin liver uptake rates were marginal (1.8-3.0%/min/m(2)), despite acceptable clinical and laboratory parameters. Posttreatment liver functions seriously declined (corrected Tc-99m-mebrofenin liver uptake rates: 0.6-2.4%/min/m(2)), resulting in lethal radioembolization-induced liver disease in two out of three patients. Conclusions: Hepatobiliary scintigraphy may be of added value during work-up for radioembolization, to estimate liver function reserve and its segmental distribution, especially in patients with underlying cirrhosis, for whom analysis of clinical and laboratory parameters may not be sufficient.