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

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.

探讨SPECT肝细胞显像评价肝硬化程度

目的 评价肝硬化患者的肝细胞功能及肝硬化程度 .方法 对 2 5例肝硬化患者及 13例正常对照组 ,进行肝胆动态显像 ,通过三室模型获得肝细胞摄取、排泄功能的放射性 -时间曲线 ,计算肝细胞摄取和排泄等功能指标 .结果 肝硬化组高峰时间、平均残存时间均显著高于正常对照组 ,均p <0 .0 0 1.肝硬化组与正常组比较高峰值摄取指数、摄取斜率、排泄斜率均显著降低 ,均p <0 .0 1.结论 肝细胞显像是一种灵敏评价肝细胞代谢功能的无创性方法 。

经直肠－门脉放射性核素成象测定肝硬变大鼠门脉系统分流

应用四氯化碳法制作大鼠肝硬变门脉高压症模型。采用￣（９９ｍ）Ｔｃ－甲氧基异丁基异腈经直肠－门脉放射性核素成象法对８例肝硬变大鼠和８例对照大鼠的门脉系统侧支循环进行了研究。结果表明：肝硬变组门体分流率（ＳＩ∶２０．０±１１．８％）明显高于对照组门体分流率（ＳＩ：７．７±８．２％）（Ｐ＜０．０１），ＳＩ与门静脉压力之间的相关关系无统计意义（ｒ＝０．２９，Ｐ＞０．０５）。

核素显像法门体分流率测定的动物模型实验及临床应用评价

目的 应用 99m Tc0 4 直肠门脉显像定量门体分流率 ,与生理测压法结果进行比较 ,探讨本法的可靠性和临床价值。方法 2 0只狗及 2 2例肝硬化病人及 8例正常对照 ,直肠给入 1 0 m Ci 99m Tc0 4 后动态采集 ,计算门体分流率 ,与生理测压法结果进行相关分析。结果 核素显像法测得正常动物门体分流率与生理测压法所得结果无显著性差异 (P>0 0 5) ,呈高度正相关 (r=0 62 9)。核素显像法测得正常对照者的门体分流率为 4 0 0 %± 1 61 % ,与生理测压法相比无显著性差异 (P>0 0 5) ,呈高度正相关 (r=0 675)。核素显像法测得门脉高压症患者行分流术前后的门体分流率差异显著 (P<0 0 0 1 ) ,在门脉高压症患者与正常对照者存在显著性差异 (P<0 0 0 1 )。结论 核素显像法门体分流率测定 ,结果可靠 ,方法简便易行 ,可重复测定 ,具有较高的临床价值。

SPECT肝细胞显像评价肝硬化程度

目的评价肝硬化患者的肝细胞功能及肝硬化程度。方法对30例肝硬化患者及15例正常对照组,进行肝胆动态显像,通过三室模型获得肝细胞摄取、排泄功能的放射性-时间曲线,计算肝细胞摄取和排泄等功能指标。结果肝硬化组高峰时间、平均残存时间均显著高于正常对照组(均P＜0．01)；肝硬化组与正常组比较高峰值摄取指数、摄取斜率、排泄斜率均显著降低(均P＜0．01)。结论肝细胞显像是一种灵敏评价肝细胞代谢功能的无创性方法,可用于分析肝硬化程度。