Angioscintigraphic Assessment of Arterial and Portal Liver Blood Flow: Comparison with Splanchnic Angiography

Visceral radiocolloid angiography was performed in 1230 consecutive patients studied with scintigraphy of the reticuloendothelial system (RES). The hepatic arterial flow was considered increased if an early and obviously increased accumulation of the radiocolloid occurred in the liver during the visceral radionuclide angiography, i.e. that the early part of the liver time-activity curve coincided with the early parts of the kidney and spleen time-activity curves with respect to time and steepness. A generalized increase of arterial blood flow to the liver was found in 70 patients, of whom 54 per cent had alcoholic liver disease, 20 per cent metastatic liver disease, 19 per cent had various diagnoses, and in 7 per cent no certain diagnosis was found. Generalized increase of arterial blood flow to the liver gives a typical appearance in radiocolloid angiography and the corresponding time-activity curves. It may be a sign of severe disease, most often localized in the liver, but in some cases it may be of extrahepatic origin. In 27 per cent it was the only obvious pathologic finding. It was in a few cases a reversible condition. Generalized increase of arterial blood flow to the liver is a clinically important finding that could escape detection if radionuclide angiography is not included in the RES scintigraphy.

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“…An arterialization index, i.e. a ratio between the arterial slope and the portal slope has then been calculated (2, 6, 15, 16,18,20,22).…”

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confidence: 99%

Generalized Increase of Arterial Blood Flow to the Liver Observed at Visceral Radiocolloid Angiography

Rudberg¹,

Hesser²,

Udén³

1989

Acta Radiol

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show abstract

“…An arterialization index, i.e. a ratio between the arterial slope and the portal slope has then been calculated (2,6,15,16,18,20,22).…”

mentioning

confidence: 99%

Generalized Increase of Arterial Blood Flow to the Liver Observed at Visceral Radiocolloid Angiography

1989

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Visceral radiocolloid angiography was performed in I 230 consecutive patients studied with scintigraphy of the reticuloendothelial system (RES). The hepatic arterial flow was considered increased if an early and obviously increased accumulation of the radiocolloid occurred in the liver during the visceral radionuclide angiography, i.e. that the early part of the liver time-activity curve coincided with the early parts of the kidney and spleen time-activity curves with respect to time and steepness. A generalized increase of arterial blood flow to the liver was found in 70 patients, of whom 54 per cent had alcoholic liver disease, 20 per cent metastatic liver disease, 19 per cent had various diagnoses, and in 7 per cent no certain diagnosis was found. Generalized increase of arterial blood flow to the liver gives a typical appearance in radiocolloid angiography and the corresponding time-activity curves. It may be a sign of severe disease, most often localized in the liver, but in some cases it may be of extrahepatic origin. In 27 per cent it was the only obvious pathologic finding. It was in a few cases a reversible condition. Generalized increase of arterial blood flow to the liver is a clinically important finding that could escape detection if radionuclide angiography is not included in the RES scintigraphy.

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“…Increased HPI (> 40%) in CLD shows the decrease of portal inflow with reactive increase of the flow through the hepatic artery by activation of the buffer response firstly described by Lautt [21,22] . The decrease of portal inflow in advanced CLD is mainly determined by the quantity of blood deviated through portosystemic shunts [23][24][25] . In cirrhosis, HPI > 100% highlights the reversion of portal flow.…”

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confidence: 99%

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

Dragoteanu

Balea²,

Dina³

et al. 2008

WJG

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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. e a m , d e s i g n e d a n d c o o r d i n a t e d t h e s t u d y, m a d e t h e interpretation of the results, introduced the new parametersand classification, worked on the preparation and revision of the manuscript and on the statistical analysis of data; Balea IA assisted with the manuscript preparation and revision and the statistical analysis of data; Dina LA participated in the selection and follow up of the patients, the statistical analysis of the data and the evaluation of the per-rectal portal scintigraphy classical method based on the per-rectal portal shunt index; Piglesan CD, Tamas S as physicists were members of the investigation team; Grigorescu I participated in the selection and follow up of the patients and assisted with the statistical analysis of the data; Cotul SO is a retired honorary professor. As chief of laboratory before 2002 he introduced the classic per-rectal portal scintigraphy and liver angioscintigraphy into practice in this hospital and was a member of the investigation team.

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Angioscintigraphic Assessment of Arterial and Portal Liver Blood Flow: Comparison with Splanchnic Angiography

Cited by 3 publications

References 4 publications

Generalized Increase of Arterial Blood Flow to the Liver Observed at Visceral Radiocolloid Angiography

Generalized Increase of Arterial Blood Flow to the Liver Observed at Visceral Radiocolloid Angiography

Generalized Increase of Arterial Blood Flow to the Liver Observed at Visceral Radiocolloid Angiography

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

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