A Case Report on Intrahepatic Cholangiocarcinoma with Suspected Indocyanine Green Excretory Defects: Clinical Decision Making for Hepatic Reserve Function Assessment?

A Case Report on Intrahepatic Cholangiocarcinoma with Suspected Indocyanine Green Excretory Defects: Clinical Decision Making for Hepatic Reserve Function Assessment? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Case Report on Intrahepatic Cholangiocarcinoma with Suspected Indocyanine Green Excretory Defects: Clinical Decision Making for Hepatic Reserve Function Assessment? Tao Wang, Wenwu Wan, Liping Zhuang, Ding Xiong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7525349/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Indocyanine green (ICG), an organic dye with good fluorescence properties, is mainly excreted through the liver. The ICG test is widely used for the preoperative assessment of liver reserve function in partial hepatectomy or for marking the resection range of the lesion during the operation. Defects in the ICG excretory areextremely rare. When combined with liver tumors, these methodsoften causegreat confusion in clinical decision-making for such patients. Case presentation: In this study, we reported a case of intrahepatic cholangiocarcinoma complicated by suspected dysfunction in indocyanine green excretory defect. The patient underwent a subsequent successful surgical intervention; however, disease recurrence and metastasis were observed during follow-up. We conducted a comprehensive review of the existing literature on similar cases and summarized current methods for assessing liver function. Based on an analysis of the strengths and limitations of these methods, we proposed several recommendations for clinical practice. Conclusions: When the ICG clearance test reveals an isolated abnormality while other diagnostic evaluations remain normal, we suggest further assessment via the ALICE grading system. If the ALICE grade is 1, surgical resection may proceed directly. However, if the ALICE grade is 2 or 3, additional diagnostic tools—such as three-dimensional liver imaging, liver elastography, and the liver maximum capacity (LiMAx) test—should be employed to more accurately evaluate functional liver reserve (FLR). For patients diagnosed with ICG excretory defects, gadoxetic acid disodium (Gd-EOB)-enhanced magnetic resonance imaging (MRI) or scintigraphy should be avoided whenever possible, as these modalities rely on the function of organic anion transporting polypeptides (OATP1B1 and OATP1B3), which may also be impaired. excretory defect intrahepatic cholangiocarcinoma ICG partial hepatectomy liver reserve function Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7525349","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":509587863,"identity":"1d7198f8-514f-4edb-a652-30e48448df8a","order_by":0,"name":"Tao Wang","email":"","orcid":"","institution":"Meishan City People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Wang","suffix":""},{"id":509587864,"identity":"cc8ce3f2-1614-4038-9f63-1c57d69ca91c","order_by":1,"name":"Wenwu Wan","email":"","orcid":"","institution":"Meishan City People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenwu","middleName":"","lastName":"Wan","suffix":""},{"id":509587865,"identity":"14a5cf10-ba0d-45a0-bd9f-1cb7cff09c07","order_by":2,"name":"Liping Zhuang","email":"","orcid":"","institution":"Meishan City People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liping","middleName":"","lastName":"Zhuang","suffix":""},{"id":509587866,"identity":"2aa5ba94-2833-4d1b-a259-b24b22e6b3a6","order_by":3,"name":"Ding Xiong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYLACHga5ejaGwwcfkKLFOIGf8ViyAWlaJJvPmEkQpdrg+NnDL95UGOQZHDtjVvGmjEGeX+wAAS1n8tIs55wxKDY4c6zs5pxzDIYzZyfg12J2IMfMmLftD+OGG4e33eZtY0gwuE1Iy/k3IC0GjBvuPzArJk7LjRzjx0AtiTMbjpgxE6XF/sYbM0agX4z5GY4lS845J0HYL5L9OcYfgCEmB4rKD2/KbOT5pQloAQI2RHTwsBEXNcwfkLQQpWMUjIJRMApGGAAAhpJI8SdEQyYAAAAASUVORK5CYII=","orcid":"","institution":"Meishan City People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ding","middleName":"","lastName":"Xiong","suffix":""}],"badges":[],"createdAt":"2025-09-03 09:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7525349/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7525349/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105897569,"identity":"5b37487a-df5b-4b58-b5c3-8522c32f2073","added_by":"auto","created_at":"2026-04-01 08:57:38","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":903259,"visible":true,"origin":"","legend":"","description":"","filename":"reviewedmanuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7525349/v1_covered_0ac0e05f-6ba5-44d1-adb1-f8ff87c41b6a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Case Report on Intrahepatic Cholangiocarcinoma with Suspected Indocyanine Green Excretory Defects: Clinical Decision Making for Hepatic Reserve Function Assessment?","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"excretory defect, intrahepatic cholangiocarcinoma, ICG, partial hepatectomy, liver reserve function","lastPublishedDoi":"10.21203/rs.3.rs-7525349/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7525349/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIndocyanine green (ICG), an organic dye with good fluorescence properties, is mainly excreted through the liver. The ICG test is widely used for the preoperative assessment of liver reserve function in partial hepatectomy or for marking the resection range of the lesion during the operation. Defects in the ICG excretory areextremely rare. When combined with liver tumors, these methodsoften causegreat confusion in clinical decision-making for such patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e In this study, we reported a case of intrahepatic cholangiocarcinoma complicated by suspected dysfunction in indocyanine green excretory defect. The patient underwent a subsequent successful surgical intervention; however, disease recurrence and metastasis were observed during follow-up. We conducted a comprehensive review of the existing literature on similar cases and summarized current methods for assessing liver function. 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