Ann Nucl Med. 2026 Jul 26. doi: 10.1007/s12149-026-02265-2. Online ahead of print.
ABSTRACT
OBJECTIVES: In this study, we aimed to evaluate the association between liver clearance values obtained from pre-treatment [⁹⁹ᵐTc]mebrofenin hepatobiliary scintigraphy and conventional liver function scores and biochemical parameters, and to perform an exploratory prognostic assessment of whether baseline clearance is associated with post-treatment outcomes, including overall survival, prior to ⁹⁰Y radioembolization. We also compared the functional assessment of the treatment region (based on mebrofenin uptake) with its anatomical CT volume (derived from [⁹⁹ᵐTc]macroaggregated albumin SPECT/CT) to determine the concordance between functional and volumetric data.
METHODS: Pre-treatment [⁹⁹ᵐTc]mebrofenin and [⁹⁹ᵐTc]MAA scintigraphies were performed in 19 patients scheduled to receive Yttrium-90 (90Y) microsphere therapy. Mebrofenin clearance was calculated, and its association with biochemical parameters and overall survival was examined. The functional definition of the planned treatment territory was estimated based on mebrofenin uptake, and this was compared with the anatomical volume of the same region on MAA SPECT/CT.
RESULTS: Mebrofenin liver clearance showed significant (p < 0.05) negative correlations with pre- and post-treatment total and direct bilirubin levels and a positive correlation with post-treatment albumin. Clearance also demonstrated a strong inverse correlation with ALBI score (p < 0.05). Among biochemical changes, only the post-treatment change in direct bilirubin was significantly associated with clearance (p < 0.05). Functional and volumetric definitions of the treatment area showed strong correlation (ρ = 0.837, p < 0.001). In five patients with target ratio greater than 50% of liver volume, functional definition was not concordant with volumetric estimates. The difference in clearance values between patients surviving ≤ 6 months and > 6 months did not reach statistical significance. Among liver function scores, Child-Pugh exhibited the strongest, though non-significant, correlation with survival (ρ = – 0.407, p = 0.084).
CONCLUSION: [⁹⁹ᵐTc]mebrofenin scintigraphy correlated with both pre- and post-treatment biochemical liver function parameters. The functional definition of the treatment region assessed by scintigraphy and volumetric definition derived from SPECT/CT were also well concordant. The difference in clearance values between patients surviving ≤ 6 months and > 6 months did not reach statistical significance. Discrepancies between volumetric and functional definitions were observed in patients with extensive target volume (> 50% of liver volume). These preliminary findings suggest that [⁹⁹ᵐTc]mebrofenin scintigraphy may complement anatomical volumetry in the pretreatment assessment of functional liver reserve, but its potential role in individualized dosimetry requires confirmation in larger prospective studies.
PMID:42503047 | DOI:10.1007/s12149-026-02265-2
