Prediction of postoperative liver failure in patients diagnosed with HCC using ^99mTc-GSA SPECT/CT

Although relatively rare in the Western countries, hepatocellular carcinoma (HCC) is the third cause of death due to cancer in the world and its incidence increases each year (1,2). Complete excision remains the treatment of choice, whether by liver resection or liver transplantation. In patients considered for liver resection, assessment of the future remnant liver (FRL) is of utmost importance in order to prevent postoperative liver failure. Computed tomography (CT) volumetry is the most widely used method in the preoperative assessment of the FRL, but, although it is the gold standard, does not provide any information on the function of FRL and its role in the preoperative work-up for liver surgery is therefore questionable (3). The same accounts for the laboratory liver function tests as they merely offer an approximation of the liver’s metabolic processes as an entire organ (i.e., uptake, synthesis, biotransformation and excretion) (4).