HEPATIQ is useful to hepatologists, gastroenterologists, oncologists, interventionists, liver surgeons, nuclear medicine physicians and radiologists. Scroll down for details about each specialty.
Hepatologists, gastroenterologists and internists
Hepatologists, gastroenterologists and internists manage patients with liver disease. They use blood tests, elastography and biopsies for diagnosis and prognosis. These are all fibrosis based assessments of the liver. However, the liver regenerates and blood flow to the liver increases to compensate for fibrosis.
The liver gets its blood (hepatic flow) from the heart (arterial flow) and from the gut (splanchnic flow). Some of the splanchnic flow does not reach the liver due to collateral shunts. Some of the hepatic flow is effectively lost due to intra-hepatic shunts. These intra-hepatic hemodynamic abnormalities (IHHA) play an important role in tissue perfusion and clearance. Fibrosis measurements entirely miss the IHHA of chronic liver disease.
Thus, an F4 patient may be H0 or H1 and may remain stable for years or decades. On the other hand, an F4 patient may be H2 or H3 and may be at risk of decompensation.
Furthermore, abnormal liver patients (>F0) may be sicker than the fibrosis measurement suggests[A-B]. For better diagnosis and prognosis, HEPATIQ may be used to assess liver functional reserve for abnormal liver patients (>F0) .
Oncologists, interventionists and liver surgeons.
Liver transplantation (LT) has the greatest cure potential for hepatocellular carcinoma (HCC) patients.
Bridge therapies prior to LT include stereotactic body radiation therapy (SBRT), Yttrium-90 radioembolization (Y90), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and surgical resection.
The figure shows a SPECT image of the liver after Y90 therapy. Notice the dark region in the middle of the liver indicating the large volume of liver tissue (tumor and non-tumor) destroyed by the radiation.
A 2022 publication in The Journal of Hepatology, “The importance of liver functional reserve (LFR) in the non-surgical treatment of hepatocellular carcinoma” by D’Avola et al [C], discusses the role of LFR and efforts to estimate it. The paper concludes that “patients with compensated cirrhosis and large liver functional reserve can always receive the most radical treatment”.
However, “a more detailed and individualized assessment should be carried out in patients with poorer liver functional reserve”. HEPATIQ may be used to assess the patient's liver functional reserve before an intervention or surgery.
Nuclear Medicine physicians and radiologists
Nuclear medicine physicians and radiologists can Increase utilization of their SPECT or SPECT/CT scanner by adopting a new application - HEPATIQ. The scan is reimbursed by insurance under CPT 78803 and can boost revenues.
HEPATIQ allows nuclear medicine to provide referring physicians with quantitative liver function data not available from any other technique - blood tests, elastography (ultrasound or MR), or even a biopsy.
HEPATIQ is pure software and uses existing equipment, radioisotope, infrastructure and staff. No capital investment is needed. Click insurance codes and reimbursement revenues for more details.