Dynamic liver scanning in cirrhosis

McLaren, Mairi; Fleming, John; Walmsley, B.H.; Ackery, D. M.; Taylor, I.; Karran, S. J.

doi:10.1002/bjs.1800720520

Cited by 11 publications

(2 citation statements)

References 8 publications

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“…This particular technique has been utilized to measure the effects of cirrhosis on the haemodynamics of the liver (Mclaren et al, 1985). A variant of the technique has also been used to evaluate deranged liver blood flow patterns in the detection of occult hepatic micometastases (Leveson et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

“…Only those tumour regions that were well-defined (identified by the absence of colloid uptake in the final image) were used for analysis. Of the seven patients with hepatomas, five had cirrhosis and the mesenteric fraction of a region uninvolved by tumour may reflect changes in the relative haemodynamics incurred by the hepatic parenchyma (Mclaren et al, 1985).…”

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Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy

Flowerdew¹,

McLaren²,

Fleming³

et al. 1987

Br J Cancer

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Summary Liver and tumour blood flow has been studied in 30 patients with multiple liver metastases and in 14 patients with solitary liver tumours by means of dynamic hepatic scintigraphy. Observations were compared with those of a group of 33 control subjects. Haemodynamic changes were also measured in 10 patients who underwent hepatic arterial embolization (HAE).The mesenteric fraction (MF) to tumour regions in 32 subjects showed a wide range compared with control subjects. In 9 patients the MF to the tumour region was within the normal range suggesting that some tumours may possess a portal venous supply. The MF to the uninvolved liver regions was below the normal range in 25% of patients, indicating that HAE could be hazardous in this group. Following HAE the MF rose in all 4 tumour regions and fell in 4 non-embolized uninvolved liver regions. No increase in colloid clearance rate (k) was seen though a significant decrease occurred in 4 patients. These changes may well represent increased portal venous flow into tumours.The treatment of malignant liver neoplasms, apart from those that are truly solitary and accordingly suitable for resection, has been unrewarding in terms of prolonging survival (Taylor, 1985). Since therapeutic ligation of the hepatic artery was first performed for a liver tumour (Reinhoff & Woods, 1953), various forms of hepatic arterial manipulation have been attempted because tumour neovascularization is predominantly arterial (Breedis & Young, 1954). The hope was that hepatic arterial occlusion might result in tumour regression and increased survival. Unfortunately, initial optimism has largely been unrealized. Morbidity and mortality associated with the procedures (Almersjo et al., 1972) as well as the development of arterial collaterals (Bengmark & Rosengren, 1970) has been responsible for the limited benefit in terms of survival.A recent and perhaps more rational method of dearterialization is by percutaneous radiological hepatic arterial embolization (HAE). Laparotomy is avoided and should the vessels recanalise or arterial collaterals develop, they can be embolized at a later date. Although there is good evidence that this procedure provides temporary palliation of symptoms from the carcinoid syndrome (Odurny & Birch, 1985), the effects on survival have not been marked, particularly in other types of liver metastases (Chuang & Wallace, 1981). However, pain due to stretching of the liver capsule by metastases can sometimes be relieved.In general, the contribution of the portal vein has largely been ignored as a potential source of significant tumour blood flow and nutrition, particularly following dearterialisation procedures, principally because of the difficulty of studying relative hepatic haemodynamics in vivo. Dynamic hepatic scanning The validity of dynamic liver scanning using 99mTc sulphur colloid has been established in animals (Fleming et al., 1981) and humans (Fleming et al., 1983). Each study is performed with the patient fasted overnight beforehand. A rapid intravenous in...

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confidence: 99%

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confidence: 99%

Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy

Flowerdew¹,

McLaren²,

Fleming³

et al. 1987

Br J Cancer

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Changes in the hepatic perfusion index during the development of experimental hepatic tumours

Nott

Grime

Yates

et al. 1989

Journal of British Surgery

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A model of microscopic liver tumour has been developed in the Fisher rat by intraportal injection of 1.6 x 10(7) Walker 256 carcinosarcoma cells. Rats were studied at 2, 4 and 6 days after the inoculation of live Walker cells. A control group received dead Walker cells. No tumour was visible in control groups at 2, 4 and 6 days after inoculation. Similarly in rats injected with live cells no tumour was visible at 2 days after inoculation but at 4 and 6 days the percentage hepatic replacement was (mean +/- s.d.) 7.0 +/- 2.3 and 27.9 +/- 6.80 respectively. The hepatic perfusion index was significantly raised at 4 and 6 days after inoculation of live cells compared with control animals and those receiving viable cells after 2 days inoculation. Portal flow and portal venous inflow were significantly reduced when the hepatic perfusion index increased but hepatic arterial flow did not alter. Changes in the hepatic haemodynamics were accompanied by increases in the portal and splanchnic vascular resistance and an increase in the amount of arteriovenous shunting through the liver. These findings confirm studies that the hepatic perfusion index is useful in the detection of occult liver metastases but that the change is not a consequence of an increase in the hepatic arterial flow.

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Hepatobiliary disease

Ackery¹

1991

Clinical Nuclear Medicine

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Dynamic liver scanning in cirrhosis

Cited by 11 publications

References 8 publications

Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy

Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy

Changes in the hepatic perfusion index during the development of experimental hepatic tumours

Hepatobiliary disease

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