Hepatic Function Assessment in Liver Surgery

Hepatic function assessment has become integral to the planning and execution of liver resection and transplantation. Traditional evaluation of global liver function relies on biochemical markers and dynamic clearance tests such as indocyanine green. However, these methods lack regional resolution critical for determining the functional capacity of future liver remnants. Recent advances combine volumetric imaging with functional tracers to map segmental uptake and excretion profiles. Techniques including hepatobiliary scintigraphy and advanced tomographic modalities allow quantification of total and regional function, guiding decisions on the extent of resection or the need for portal vein embolisation. Emerging positron emission tomography tracers further enhance spatial and temporal resolution, enabling detection of subclinical dysfunction and prediction of post-hepatectomy liver failure. Integration of functional and volumetric data underpins personalised surgical strategies, reducing postoperative morbidity and mortality. As liver surgery extends to more complex and marginal patients, accurate hepatic function assessment has become indispensable for optimising outcomes and preserving quality of life.

Research from Nature Portfolio

Foundational work has introduced combined laser speckle perfusion imaging and in vivo optical fluorescence to monitor hepatic microcirculation and reserve. In an animal model of acute liver injury, simultaneous assessment of blood perfusion and indocyanine green distribution demonstrated a direct link between microvascular flow impairment and functional decline. This dual-modality approach offers a translational framework for non-invasive mapping of regional function and therapeutic response, paving the way for real-time intraoperative monitoring and improved prediction of liver reserve in surgical candidates.

Hepatic Function Assessment in Liver Surgery publication trend

The graph below shows the total number of articles in hepatic function assessment in liver surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Indocyanine green clearance test: A dynamic blood test measuring the rate of hepatic uptake and elimination of indocyanine green dye, reflecting global liver function.

LiMAx test: A breath-based assay quantifying liver maximum capacity by measuring metabolism of a 13C-labelled substrate, indicative of enzymatic function.

Hepatobiliary scintigraphy: A nuclear imaging technique in which radiolabelled agents are taken up and excreted by hepatocytes, enabling quantification of total and segmental liver function.

Single-photon emission computed tomography (SPECT): A tomographic imaging modality using gamma-ray-emitting tracers to create three-dimensional maps of tracer distribution within the liver.

Future liver remnant (FLR): The portion of liver parenchyma that remains post-resection, whose functional capacity is critical to preventing postoperative liver failure.

References

1. Predictability of combining Technetium-99m-galactosyl human serum albumin single-photon emission computed tomography/computed tomography and indocyanine green clearance test for posthepatectomy liver failure. Japanese Journal of Radiology (2024).
2. Perioperative LiMAx Test Analysis: Impact of Portal Vein Embolisation, Chemotherapy and Major Liver Resection. Biomedicines (2024).
3. Liver PET Reloaded: Automated Synthesis of [68Ga]Ga-BP-IDA for Positron Imaging of the Hepatobiliary Function and First Clinical Experience. Diagnostics (2023).
4. Evaluation of liver function and electroacupuncture efficacy of animals with alcoholic liver injury by the novel imaging methods. Scientific Reports (2016).