Nuclear Imaging of Hepatic Function in Liver Surgery and Transplantation

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 10, 2026:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 1.25
Procedures: 1.25
Gastrointestinal and Genitourinary Procedures: 1.25

Outline

1. Introduction
2. The Development of New Techniques for Assessment of Liver Function
3. 99mTc-GSA Scintigraphy
   1. Background
   2. Kinetics and Quantitative Measurement of Liver Function
   3. 99mTc-GSA Liver Scintigraphy in Experimental Surgical Research
   4. Clinical Use of 99mTc-GSA Liver Scintigraphy in Liver Surgery
   5. Clinical Use of 99mTc-GSA Liver Scintigraphy in Liver Transplantation
4. HBS with IDA Derivatives
   1. Background
   2. The Kinetics and Quantitative Measurement of Liver Function
   3. HBS in Experimental Surgical Research
   4. Clinical Use of HBS in Liver Surgery
   5. Clinical Use of HBS in Liver Transplantation
5. Discussion
6. Conclusion

Objectives

Upon completion of this course, students will:

1. identify the most effective treatment for hepatic malignancies
2. explain what contributes to postoperative liver failure in patients with com-promised liver parenchyma
3. explain the purpose for portal vein embolization (PVE)
4. identify the most frequently used quantitative liver function test in liver surgery and transplantation
5. understand what CT volumetry primarily assess in liver surgery
6. list the imaging characteristics of ¹³¹I-rose bengal and liver imaging
7. understand how ^99mTc-GSA specifically binds to in the liver
8. describe the correlation with ^99mTc-GSA and conventional liver function tests, especially in cirrhotic patients
9. identify what the most accurate index for hepatic function is
10. understand which parameter from planar ^99mTc-GSA imaging reflects hepat-ic uptake ratio at 15 minutes
11. explain how static ^99mTc-GSA SPECT can assess the liver
12. describe the causes of decreased hepatic ^99mTc-GSA uptake in prolonged obstructive jaundice in rats
13. identify what measure is an independent preoperative predictor of complica-tions in patients with chronic liver disease
14. explain what imaging technique proved useful for predicting remnant liver function in the setting of cirrhosis
15. understand how PVE affected the relationship between FRL function in-crease and volume increase
16. identify which techniques best evaluate liver regeneration in the setting of fibrosis
17. identify which imaging method showed better correlation with actual graft function after auxiliary partial liver transplantation
18. explain which imaging method for FRL function estimation proved useful for hepatectomy selection with living doner liver transplantation
19. list the characteristics of ^99mTc-IDA agents
20. identify what factors can hinder ^99mTc-IDA uptake adversely affecting cho-lescintigraphy
21. understand the rationale for using radioactivity values between 150 and 350 seconds after ^99mTc-mebrofenin injection
22. explain how FRL uptake of ^99mTc-mebrofenin is calculated during liver func-tion assessment
23. describe the process of ^99mTc-mebrofenin and FRL uptake
24. explain what can confound total and regional liver function using ^99mTc-mebrofenin SPECT
25. identify what accurate, noninvasive tool can be used for measuring liver function and monitoring regeneration in rat models
26. identify the minimum FRL uptake associated with a safe liver resection
27. explain the advantages of SPECT/CT HBS over planar imaging
28. list features that a HBS test can offer
29. describe the findings that Bennink et al. discovered regarding functional and volumetric liver regeneration using HBS
30. list the imaging features associated with hepatobiliary scintigraphy in liver transplantation
31. identify the diagnostic technique that is uniquely capable of separately as-sessing the function of both graft and native liver in heterotopic auxiliary liver transplantation
32. identify how HBS has been used to study in living donor liver transplantation
33. list a limitation associated with ^99mTc-GSA scintigraphy that cannot be used diagnostically following liver surgery or transplantation
34. explain why ^99mTc-GSA SPECT preferred over ^99mTc-mebrofenin HBS in small laboratory animals
35. identify a key feature offered by both ^99mTc-GSA scintigraphy and ^99mTc-mebrofenin HBS