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Table 4 Details of the diagnostic characteristics and predictive values of preoperative nuclear medicine imaging and computed tomography or magnetic resonance imaging for predicting postoperative liver failure (both combined functional/morphological parameters and separate morphological and functional parameters)

From: Comparison of nuclear imaging techniques and volumetric imaging for the prediction of postoperative mortality and liver failure in patients undergoing localized liver-directed treatments: a systematic review

Author Cutoff value (variable: value and unit) LF versus no LF (mean or median, p-value) Key diagnostic characteristics Univariable regression analysis (impact, p-value) Multivariable regression analysis (impact, p-value) Significant differences in key diagnostic characteristics between NMI and CT/MRI
Chapelle et al. [18] NMI:
TLF: NR (%/min)a
5.0 versus 6.2 (p = 0.020) NR NR (p = 0.027) NR (NS) NR
CT:
FLRV%: 40 (%)
49 versus 76 (p < 0.001) Sens 71%, spec 91%, PPV 41%, NPV 97%, AUC 0.77 For FLRV% < 40:
OR 26 (p < 0.001)
NR (NS)
NMI/MRI combined: eFLRF: 2.3 (%/min/m2) 2.2 versus 4.7 (p < 0.001) Sens 92%, spec 98%, PPV 92%, NPV 99%, AUC 0.89 For eFLRF < 2.3:
OR 836 (p < 0.001)
NR (p = 0.001)
Chapelle et al. [26] NMI:
HBSBSA: NR (%/min)a
5.5 versus 6.1 (NS) AUC 0.652 NR (NS) NR (NR) NR
CT:
FLRV%: NR (%)
60.6 versus 80.9 (p < 0.001) AUC 0.800 NR (p < 0.001) NR (NR)
NMI/MRI combined: eFLRF: 2.3 (%/min/m2) 3.3 versus 8.4 (p < 0.001) AUC 0.843 NR (p < 0.001) OR 0.35 (p = 0.002)
Cho et al. [14] NMI:
SUVmean: 2.4
2.1 versus 2.3 (NS) Sens 100%, spec 32%, PPV 7%, NPV 100% For SUVmean ≤ 2.4: OR 7.0 (NS) NR (NR) NR
CT:
Predicted remnant hepatic volume: 415.8 (cm3)
488.5 versus 652.3 (NS) Sens 71%, spec 81%, PPV 16%, NPV 98% For predicted remnant hepatic volume ≤ 415.8:
OR 10.6 (p = 0.006)
NR (NS)
CT:
RFRHV: 0.3
0.4 versus 0.5 (p = 0.007) Sens 71%, spec 88%, PPV 23%, NPV 98% For RFRHV ≤ 0.3:
OR 18.4 (p = 0.001)
NR (NS)
NMI/CT combined:
TLGr: 625.6
1067 versus 1491 (NS) Sens 57%, spec 97%, PPV 44%, NPV 98% For TLGr ≤ 625.6:
OR 36.5 (p < 0.001)
For TLGr ≤ 625.6:
OR 82.9 (p < 0.001)
de Graaf et al. [10] NMI:
FRL-F: 2.69 (%/min/m2)
2.2 versus 4.3 (p = 0.001) Sens 89%, spec 87%, PPV 57%, NPV 98%, AUC 0.92 NR (NR) NR (NR) NR
CT:
%FRL-V: < 30 (normal liver), < 40 (compromised liver) (%)
35.0 versus 49.7 (p = 0.013) Sens 78%, spec 80%, PPV 44%, NPV 95% NR (NR) NR (NR)
CT:
sFRL: < 30 (normal liver), < 40 (compromised liver) (%)
35.2 versus 49.2 (p = 0.018) Sens 67%, spec 87%, PPV 50%, NPV 93% NR (NR) NR (NR)
Dinant et al. [19] NMI:
FRL-uptake: 2.5 (%/min/BSA)
2.3 versus 4.3 (p = 0.003) Sens 83%, spec 90%, PPV 56%, NPV 97%, AUC 0.90 NR (p = 0.01) OR 4.0 (p = 0.03) NR
CT:
FRL-volume: NR (%)
42 versus 52 (NS) AUC 0.65 NR (NR) NR (NR)
Hayashi et al. [20] NMI:
Marginal FR function: depending on ICG-value (see paper for further information) (%)
NR (NR) NR For marginal FR function versus safe FR function:
OR 11.0 (p = 0.001)
NR (NR) NR
CT:
Marginal FR volume: depending on ICG-value (see paper for further information) (%)
NR (NR) NR For marginal FR volume versus safe FR volume:
OR 2.3 (NS)
NR (NR)
Hirai et al. [24] NMI:
[99mTc]Tc-GSA uptake in the FLR: 25 (%)
Before PVE: 10.0 versus 25.8 (p = 0.02)
After PVE: 18.0 versus 38.4 (p = 0.01)
Sens 50%, spec 94%, AUC 0.97b NR (NR) NR (NR) No
CT:
Ratio of FLR volume to standard liver volume: 35 (%)
Before PVE: 33.0 versus 38.5 (NS)
After PVE: 33.7 versus 46.2 (p = 0.003)
Sens 57%, spec 91%, AUC 0.93b NR (NR) NR (NR)
Kokudo et al. [17]c NMI:
LHL15: NR
0.89 versus 0.93 (p = 0.025) NR NR (NR) NR (NS) NR
NMI:
HH15: NR
0.58 versus 0.52 (NS) NR NR (NR) NR (NR)
NMI:
R0: NR (μmole)
0.14 versus 0.18 (p = 0.038) NR NR (NR) NR (NS)
NMI:
[R]0: NR (μM)
0.63 versus 0.70 (NS) NR NR (NR) NR (NR)
CT:
RPF: NR (%)
32.5 versus 27.1 (NS) NR NR (NR) NR (NR)
Combined NMI/CT:
R0-remnant: 0.16 (μmole)
0.015 versus 0.024 (p = 0.011) NR NR (NR) Per 0.01 μmole increment:
HR 0.82 (p = 0.022)
Nanashima et al. ≠ [32] NMI:
LHL15: 0.85
91.1 versus 93.1 (p = 0.014) NR NR (NR) For LHL15 < 0.85 versus ≥ 0.85:
OR 1.4 (NS)
NR
CT:
Volume of resected liver: 50 (%)
45 versus 27 (p < 0.01) NR NR (NR) For volume of resected liver ≥ 50 versus < 50%:
OR 7.0 (p = 0.027)
Okabe et al. [30] NMI:
LHL15: 0.93d
0.92 versus 0.93 (p = 0.0027) Sens: 88%, spec 96% NR (NR) For LHL15 ≤ 0.93:
OR 7.4 (p = 0.0082)
NR
NMI:
HH15: NRd
0.66 versus 0.58 (p = 0.0041) NR NR (NR) NR (NS)
CT:
%FLR: NR (%)d
50.3 versus 50.6 (NS) NR NR (NR) NR (NR)
Olthof et al. [22] NMI:
Total liver function: NR (%/min)
14.6 versus 16.2 (p = 0.41) NR NR (NR) NR (NR) NR
NMI:
FLR function: NR (%)
44.7 versus 63.4 (p < 0.01) AUC: 0.68 NR (NR) NR (NR)
NMI:
FLR function: 8.5 (%/min)
(post hoc cutoff)
5.6 versus 8.7 (p < 0.01) PPV 36%, NPV 91% e,
AUC 0.69
For FLR function < 8.5:
OR 5.4 (p < 0.01)
For FLR function < 8.5:
OR 4.1 (p < 0.01)
NMI:
sFLR function: 2.7 (%/min/m2) (predefined cutoff)
3.1 versus 4.7 (p < 0.01) PPV 38%, NPV 82% e, AUC 0.68 NR (NR) NR (NR)
CT:
FLRV%: 30 (%) (predetermined cutoff), 28.7% (post hoc cutoff)
43 versus 54 (NS) Predetermined cutoff:
PPV 56%, NPV 83%, AUC 0.60
Post hoc cutoff:
PPV 71%, NPV 83%
For FLRV% < 30:
OR 5.2 (p < 0.01)
For FLRV% < 30:
OR 3.4 (NS)
CT:
sFLRV%: NR (%/m2)
NR (NR) AUC 0.58 NR (NR) NR (NR)
CT:
FLRV: NR (mL)
760 versus 986 (NS) NR NR (NR) NR (NR)
CT:
Total liver volume: NR (mL)
2016 versus 1841 (NS) NR NR (NR) NR (NR)
Rassam et al. ≠ [23] NMI:
FRLF: 2.7 (%/min/m2) (predefined cutoff)
NR (NS) NR NR (NR) NR (NR) NR
NMI:
MUR: NR (%/min)
NR (NS) NR NR (NR) NR (NR)
CT:
FRLV%: NR (%)
NR (NS) NR NR (NR) NR (NR)
Serenari et al. [28] NMI:
FLR-C: 34.5 (%)
30 versus 41 (p = 0.011) Sens 100%, spec 82%, PPV 50%, NPV 100% NR (NR) NR (NR) NR
NMI:
FLR-F: 1.69 (%/min/m2)
0.94 versus 2.07 (p = 0.011) Sens 100%, spec 75%, PPV 50%, NPV 100% NR (NR) NR (NR)
NMI:
HIBA-i: 14.94 (%)
12.86 versus 23.29 (p = 0.001) Sens 100%, spec 94%, PPV 80%, NPV 100% NR (NR) NR (NR)
CT:
FLR/sTLV: NR (%)
35 versus 42 (NS) NR NR (NR) NR (NR)
CT:
FLR/mTLV: NR (%)
34 versus 41 (NS) NR NR (NR) NR (NR)
CT:
FLR/BW: NR (%)
0.74 versus 0.88 (NS) NR NR (NR) NR (NR)
Serenari et al. [29] NMI:
FLR-F: NR (%/min/m2)
1.72 versus 4.02 (NR) NR NR (NR) NR (NR) NR
Yoshida et al. [31] NMI:
rLUV(BSA): 27.0
23.0 versus 33.6 (p < 0.001)f Sens 91%, spec 81%, PPV 31%, NPV 99%, AUC 0.89 NR (NR) NR (p < 0.001) NR
NMI:
rLUV(BW): 0.66
NR (NR) Sens 80%, spec 84%, PPV 24%, NPV 99%, AUC 0.85 NR (NR) NR (NR)
NMI:
rLUR: 50.0 (%)
NR (NR) Sens 93%, spec 66%, PPV 15%, NPV 99%, AUC 0.87 NR (NR) NR (NR)
NMI:
HH15: NR
0.64 versus 0.60 (p < 0.05)f NR NR (NR) NR (NS)
NMI:
LHL15: NR
0.90 versus 0.91 (NS)f NR NR (NR) NR (NR)
NMI:
%remnant LF: NR (%)
60.9 versus 75.3 (p < 0.001)f NR NR (NR) NR (NS)
CT:
% remnant LV: NR (%)
61.5 versus 73.7 (p < 0.05)f NR NR (NR) NR (NS)
Combined NMI/CT:
rLUV(LV): 0.21
NR (NR) Sens 92%, spec 46%, PPV 10%, NPV 99%, AUC 0.73 NR (NR) NR (NR)
Yumoto et al. [16] NMI:
R0-remnant: 100 (nmol/liver)
62.1 versus 122.2 (p < 0.001) AUC: 0.97 NR (NR) NR (NR) NR
NMI:
[R]0: NR (nmol/l)
412 versus 551 (p = 0.045) AUC: 0.80 NR (NR) NR (NR)
NMI:
R0: NR (nmol/liver)
149.8 versus 211.2 (p = 0.047) NR NR (NR) NR (NR)
NMI:
LHL15: NR
0.79 versus 0.87 (p = 0.035) AUC: 0.74 NR (NR) NR (NR)
CT:
TLV: NR (mL)
1684.3 versus 1429.7 (NS) NR NR (NR) NR (NR)
CT:
Remnant liver volume: NR (mL)
741.7 versus 854.0 (NS) NR NR (NR) NR (NR)
CT:
RPF: NR (%)
36.9 versus 31.7 (p = 0.046) NR NR (NR) NR (NR)
  1. LF: liver failure; NMI: nuclear medicine imaging; CT: computed tomography; MRI: magnetic resonance imaging; NR: not reported; NS: not significant; OR: odds ratio; AUC: area under the curve; HR: hazard ratio; Sens: sensitivity; Spec: specificity; PPV: positive predictive value; NPV: negative predictive value; TLF: total liver function; FLRV%: the future liver remnant volume as a percentage of total liver volume; eFLRF: estimated future liver remnant function; HBSBSA: global liver function ([99mTc]Tc-mebrofenin hepatobiliary scintigraphy clearance divided by body surface area); SUVmean: mean standardized uptake value; RFRHV: ratio of remnant hepatic volume to preoperative hepatic volume; TLGr: total glycolysis of the remnant liver; FRL-F: future remnant liver uptake function; %FRL-V: future remnant liver volume as a percentage of total liver volume; sFRL: standardized future remnant liver; FRL: future remnant liver; FR: future remnant; FLR: future liver remnant; PVE: portal vein embolization; LHL15: [99mTc]Tc-GSA receptor index; HH15: [99mTc]Tc-GSA clearance index; R0: total hepatic asialoglycoprotein receptor amount; [R]0: hepatic asialoglycoprotein receptor concentration; RPF: resected parenchymal fraction; R0-remnant: total hepatic asialoglycoprotein receptor amount in the future remnant liver; %FRL: future remnant liver volume as a percentage of total liver volume; sFLRV%: standardized future liver remnant volume ratio; FRLF: future remnant liver function; FRLV: future remnant liver volume; MUR: Mebrofenin uptake rate; FLR-C: percentage of counts within the future remnant liver; HIBA-i: the HIBA-index (the proportion of radionuclide accumulated in the future remnant liver); FLR/sTLV: the ratio between future liver remnant volume and standardized total liver volume; FLR/mTLV: the ratio between future liver remnant volume and measured total liver volume; FLR/BW: the ratio between future liver remnant volume and body weight; rLUV(BSA): liver uptake value of the remnant liver corrected for body surface area; rLUR: remnant liver uptake ratio; LUV(BW): liver uptake value of the remnant liver corrected for body weight; %remnant LF: the relative residual liver function; % remnant LV: the relative residual liver volume; rLUV(LV): liver uptake value of the remnant liver corrected for liver volume; and TLV: total liver volume
  2. For the diagnostic characteristics, sensitivity, specificity, negative predictive value, positive predictive value, and area under the curve were reported if available
  3. aTLF and HBSBSA correspond to the same global liver function estimate from [99mTc]Tc-mebrofenin hepatobiliary scintigraphy, but in the two papers they are named differently
  4. bAfter PVE
  5. cFor “signs of postoperative liver failure”
  6. dReported here for patients with a %FLR (volume-based) of 35–60%, further details are provided for patients > 60% FLR in the original paper
  7. eIn the whole patient population, for information on characteristics of NMI for patients with bilirubin level < 50 μmol/L at the time of the hepatobiliary scintigraphy, see the paper
  8. fNon-preserved versus preserved liver function on postoperative day 5; non-preserved referring to moderate–severe hepatic dysfunction on postoperative day 5; and preserved referring to no or mild hepatic dysfunction on postoperative day 5