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Staging of portal hypertension and portosystemic shunts using dynamic nuclear medicine investigations

World Journal of Gastroenterology 2008年第24期14卷 3841-3848页

作者： Mircea Dragoteanu Ioan A Balea Liliana A Dina Cecilia D Piglesan Ioana Grigorescu Stefan Tamas Sabin O Cotul Department of Nuclear Medicine "ProfessorDr. Octavian Fodor" Clinical Emergency Hospital Resident doctor in nuclear medicine "ProfessorDr. Octavian Fodor" Clinical Emergency Hospital Department of Internal Medicine "ProfessorDr. Octavian Fodor" Clinical Emergency Hospital

AIM： To explore portal hypertension and portosystemic shunts and to stage chronic liver disease （CLD） based on the pathophysiology of portal hemodynamics. METHODS： Per-rectal portal scintigraphy （PRPS） was performed on 312 patients with CLD and liver angioscintigraphy （LAS） on 231 of them. The control group included 25 healthy subjects. We developed a new model of PRPS interpretation by introducing two new parameters, the liver transit time （LTT） and the circu-lation time between right heart and liver （RHLT）. LTT for each lobe was used to evaluate the early portal hypertension. RHLT is useful in cirrhosis to detect liver areas missing portal inflow. We calculated the classical per-rectal portal shunt index （PRSI） at PRPS and the hepatic perfusion index （HPI） at LAS. RESULTS： The normal LTT value was 24 ± 1 s. Abnormal LTT had PPV = 100% for CLD. Twenty-seven noncirrhotic patients had LTT increased up to 35 s （median 27 s）. RHLT （42 ± 1 s） was not related to liver disease. Cirrhosis could be excluded in all patients with PRSI 〈 5% （P 〈 0.01）. PRSI 〉 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the classification of CLD in 5 hemodynamic stages. Stage 0 is normal （LTT = 24 s, PRSI 〈 5%）. In stage 1, LTT is increased, while PRSI remains normal. In stage 2, LTT is decreased between 16 s and 23 s, whereas PRSI is increased between 5% and 10%. In stage 3, PRSI is increased to 10%-30%, and LTT becomes undetectable by PRPS due to the portosystemic shunts. Stage 4 includes the patients with PRSI 〉 30%. RHLT and HPI were used to subtype stage 4. In our study stage 0 had NPV = 100% for CLD, stage 1 had PPV = 100% for non-cirrhotic CLD, stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis, stage 4 had PPV = 100% for cirrhosis. CONCLUSION： LTT allows the detection of early portal hypertension and of opening of transhepatic shunts. PRSI is useful in CLD with extrahepatic portosystemic shunts. Our hemodynamic model stages the evolution

关键词： Chronic liver disease Portal hypertension Portosystemic shunts Per-rectal portal scintigraphy angioscintigraphy

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Nuclear medicine dynamic investigations in the diagnosis of Budd-Chiari syndrome

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World Journal of Hepatology 2014年第4期6卷 251-262页

作者： Mircea Dragoteanu Ioan-Adrian Balea Cecilia-Diana Piglesan Department of Nuclear Medicine Regional Institute for Gastroenterology and HepatologyProf.Dr.Octavian Fodor400162 Cluj-NapocaRomania

AIM:To investigate the hepatic hemodynamics in the Budd-Chiari syndrome(BCS) using per-rectal portal scintigraphy(PRPS) and liver angioscintigraphy(LAS).METHODS:Fourteen consecutive patients with BCS were evaluated by PRPS between 2003 and *** of them underwent LAS and liver scan(LS) with Tc-99m *** patients had clinical manifestations and three were asymptomatic,incidentally diagnosed at *** control group included 15 healthy *** used new parameters at PRPS,the liver transit time of portal inflow and the blood circulation time between the right heart and *** offered information on the hepatic areas missing venous outflow or portal inflow,length and extent of the lesions,open portosystemic shunts(PSS),involvement of the caudate lobe(CL) as an intrahepatic shunt and flow reversal in the splenic *** was useful in the differential diagnosis between the BCS and portal obstructions,highlightingthe hepatic artery buffer response and reversed portal *** offered complementary data,especially on the ***:We described three hemodynamic categories of the BCS with several subtypes and stages,based on the finding that perfusion changes depend on the initial number and succession in time of the hepatic veins(HVs) *** of one hepatic vein(HV) did not cause opening of *** BCS debuted by common obstruction of two HVs had different hemodynamic aspects in acute and chronic stages after subsequent obstruction of the third *** chronic stages,obstruction of two HVs resulted in opening of *** BCS,determined by thrombosis of the terminal part of the inferior vena cava,presented in the acute stage with open PSS with low speed *** least several weeks are required in the obstructions of two or three HVs for the spontaneous opening of dynamically efficient *** CL seems to have only a transient important role of intrahepatic shunt in several types of the ***:Dynamic nuclear medicine investigations

关键词： Budd-Chiari syndrome Per-rectal portal scintigraphy Liver angioscintigraphy Caudate lobe Hepatic veins

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