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Natural history of major complications in hepatitis C virus-related cirrhosis evaluated by per-rectal portal scintigraphy
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作者 Etsushi Kawamura Daiki Habu +9 位作者 Takehiro Hayashi Ai Oe Jin Kotani Hirotaka Ishizu Kenji Torii Joji Kawabe Wakaba Fukushima Takashi Tanaka Shuhei Nishiguchi Susumu Shiomi 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第25期3882-3886,共5页
AIM: To examine the correlation between the porto-systemic hypertension evaluated by portal shunt index (PSI) and life-threatening complications, including hepatocellular carcinoma (HCC), liver failure (Child-Pugh sta... AIM: To examine the correlation between the porto-systemic hypertension evaluated by portal shunt index (PSI) and life-threatening complications, including hepatocellular carcinoma (HCC), liver failure (Child-Pugh stage progression), and esophagogastric varices. METHODS: Two hundred and twelve consecutive subjects with HCV-related cirrhosis (LC-C) underwent per-rectal portal scintigraphy. They were allocated into three groups according to their PSI: group Ⅰ, PSI≤10%; group Ⅱ, 10%<PSI<30%; and group Ⅲ, 30%≤PSI. Of these, selected 122 Child-Pugh stage A (Child A) subjects were included in analysis (a mean follow-up period of 5.9±5.4 years, range 6 mo-21 years). RESULTS: No significant correlation between PSI and cumulative probability of HCC incidence was observed. Cumulative probability of Child A to B progression was tended to be higher in group Ⅲ than in group Ⅰ, and significantly higher in group Ⅲ than in group Ⅱ (62% vs 34%, 62% vs 37%; P = 0.060, <0.01; respectively). Cumulative probability of varices tended to be higher in group Ⅲ than in group Ⅰ (31% vs 12%, P = 0.090). On multivariate analyses, significant correlation between PSI and Child A to B progression was observed, and no significant correlation between PSI and HCC incidence or varices progression was observed. CONCLUSION: Patients with LC-C of Child A will progress to Child B rapidly after their PSI reaches 30% or higher. PSI can be used to predict occult progressive porto-systemic shunting and liver failure non-invasively. It indicates that PSI may play an important role in follow-up of the porto-systemic hypertension gradient for outpatients with LC unlike hepatic venous catheterization. 展开更多
关键词 portal shunt index Porto-systemic shunting per-rectal portal sdntigraphy Natural history liver cirrhosis HCV Hepatocellular carcinoma liver failure VARIX
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Staging of portal hypertension and portosystemic shunts using dynamic nuclear medicine investigations 被引量:7
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作者 Mircea Dragoteanu Ioan A Balea +4 位作者 Liliana A Dina Cecilia D Piglesan Ioana Grigorescu Stefan Tamas Sabin O Cotul 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第24期3841-3848,共8页
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 perfo... 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 of portal hypertension and portosystemic shunts. It may be of use in the selection of patients for interferon therapy. 展开更多
关键词 Chronic liver disease portal hypertension Portosystemic shunts per-rectal portal scintigraphy Angioscintigraphy
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门脉循环γ照相、B超和肝功能测定对肝硬化诊断的对比研究 被引量:2
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作者 莫耀溥 邹德环 马文伟 《中国医学影像学杂志》 CSCD 1996年第4期226-228,共3页
本文应用门脉循环γ照相测定门脉分流指数,评估其在肝硬化诊断中的作用,并与B超和5组肝功能测定进行对比。研究表明,核素门脉分流指数随着慢性肝病的肝纤维化进程不断升高,正常人<慢性肝炎<代偿期肝硬化<失代偿期肝硬化。本法... 本文应用门脉循环γ照相测定门脉分流指数,评估其在肝硬化诊断中的作用,并与B超和5组肝功能测定进行对比。研究表明,核素门脉分流指数随着慢性肝病的肝纤维化进程不断升高,正常人<慢性肝炎<代偿期肝硬化<失代偿期肝硬化。本法敏感性为92.3%,B超为77.4%,肝功能总体为70.9%;本法特异性为100%,准确率95.1%,阳性预测值100%,阴性预测值88.4%。说明门脉循环γ照相是安全、简便,早期诊断肝硬化的可靠方法。 展开更多
关键词 肝硬化 门脉循环γ照相 肝功能测定 B超
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门脉循环γ照相与彩色多普勒对肝硬化的诊断意义
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作者 邹德环 莫耀溥 +5 位作者 廖国荣 佘立群 朱旭生 焦晓风 纪平 周秀卿 《影像诊断与介入放射学》 1997年第3期165-167,共3页
为评价门脉循环γ照相与彩色多普勒对肝硬化的诊断效能,18例肝硬化患者15例正常对照同时进行门脉循环γ照相和彩色多普勒扫描。结果表明,肝硬化组门脉分流指数(SI)明显高于对照组(P<0.01).诊断肝硬化灵敏度、特异性和准确性分别为83.... 为评价门脉循环γ照相与彩色多普勒对肝硬化的诊断效能,18例肝硬化患者15例正常对照同时进行门脉循环γ照相和彩色多普勒扫描。结果表明,肝硬化组门脉分流指数(SI)明显高于对照组(P<0.01).诊断肝硬化灵敏度、特异性和准确性分别为83.3%、100.0%和90.9%。彩色多普勒扫描结果示,肝硬化组平均血液速度显著高于正常人组(P<0.05),两组门脉内径与血流量无显著差异(P>0.05),诊断肝硬化灵敏度、特异性准确性分别为66.6%、60.0%和63.6%。提示门脉循环γ照相对肝硬化化诊断意义,其诊断效能优于彩色多普勒。 展开更多
关键词 门脉循环γ照相 彩色多普勒 肝硬变 诊断
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^(99m)TC_4~-经直肠-门脉显像半定量测定肝硬化门体分流程度 被引量:3
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作者 王颖 刘述信 +3 位作者 何凤云 刘中林 刘长平 裴著果 《肝脏病杂志》 CSCD 1994年第1期26-28,共3页
本文采用 ̄(99m)TC经直肠-门脉显像法对40例肝硬化、14例对照者的门脉侧支循环进行了半定量研究。结果表明:肝硬化组病人均呈模型Ⅱ表现,对照组对象均呈模型Ⅰ表现。肝硬化组门体分流率(SI:70.0±9.5%)... 本文采用 ̄(99m)TC经直肠-门脉显像法对40例肝硬化、14例对照者的门脉侧支循环进行了半定量研究。结果表明:肝硬化组病人均呈模型Ⅱ表现,对照组对象均呈模型Ⅰ表现。肝硬化组门体分流率(SI:70.0±9.5%)明显高于对照组门体分流率(SI:18.6±5.7%)(P<0.01),在SI与门脉压之间有正相关性(γ=0.767、P<0.01)。肝硬化合并重度食道静脉曲线组SI值(77.6±5.3%)高于肝硬化合并轻度食道静脉曲张组SI值(62.0±9.9%)(P<0.01)。 展开更多
关键词 肝硬化 门体分流 经直肠 门静脉显像 锝99M
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