Quantitative 99mTc Sulfur Colloid Liver SPECT following Granulocyte Colony Stimulating Factor (G-CSF) treatment in decompensated cirrhosis: Correlation with Indocyanine Green and Clinical Scores

365 Background: Decompensated cirrhosis (DC) portends high morbidity and mortality . Liver transplant is the definitive treatment but it is limited due to high expenses, lifelong use of immuno-suppressants and other side effects. Induced hematopoietic stem cell therapy by using granulocyte Colony Stimulating Factor (G-CSF) in liver cirrhosis has shown encouraging results. Accurate estimation of functional capacity of liver is critical for predicting outcome. Indocyanine green clearance is nearby gold standard for functional evaluation of liver function. However, this test is cumbersome and has other inherent limitations. Dynamic liver function tests that can estimate spatial functional distribution is required especially in case of damaged or cirrhotic liver having functional heterogeneity. In our study we have used quantitative 99mTc sulfur colloid liver SPECT scan as a surrogate marker for quantitative assessment of liver function following G-CSF treatment in decompensated cirrhosis and correlated the results with Indocyanine Green and liver disease severity scores - Child-Turcotte-Pugh(CTP) and Model of End-stage Liver Disease(MELD). Methods: One hundred five patients with decompensated cirrhosis were prospectively enrolled in the study. Patients were randomized in two groups; group A received standard medical therapy (SMT) plus G-CSF and group B received SMT alone. Group A (n=67) received G-CSF dose of 5μg/kg subcutaneously every 12h for 5 consecutive days every 3 monthly for 1 year and group B ( n=38) received SMT alone. 99mTc sulfur colloid SPECT/CT and indocyanine green clearance test were performed at baseline and at 12 months in both groups. Quantitative liver uptake (QLU) and Indocyanine green retention at 15 min(ICG-R15) were calculated. Disease severity scores CTP and MELD were calculated on monthly follow up. Results: Quantitative liver uptake (QLU) exhibited a significant correlation with CTP (r= -0.61;p=0.001), MELD (r= -0.69; p=0.000) and ICG(R-15) (r = -0.60; p=0.001), respectively. Likewise, ICG(R-15) also showed a significant correlation with CTP (r= 0.61; p=0.001) and MELD (r= 0.53; p=0.001), respectively. QLU and CTP scores improved from (27.33 ±8.40 to 32.59 ±10.74; p=0.001) and from (8.5 (6-12) to 7 (5-9); p=0.0001) at baseline and 12 months in group A, respectively. However, QLU and CTP showed no significant change from (28.17 ± 12.63 to 21.27 ± 11.26; p=0.007) and [8(6-13) to 8 (5-18); p=0.759] at baseline and 12 months in group B, respectively. Conclusions: Quantitative 99mTc Sulfur colloid liver SPECT showed significant correlation with CTP, MELD and (ICG-R15).Also, G-CSF treatment in decompensated cirrhosis showed improvement in disease severity scores and quantitative liver uptake (QLU).Thus, quantitative 99mTc sulfur colloid SPECT scan can be used as an non-invasive, accurate and cost effective quantitative test for assessment of hepatic function in response to novel therapies.