Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

Zhao, He; Tsauo, Jiaywei; Zhang, Xiaowu; Ma, Huaiyuan; Weng, Ningna; Tang, Gongshun; Li, Xiao

doi:10.3748/wjg.v26.i10.1088

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…However, we have some concerns regarding this work. The authors appraised the shunt fraction (SF) by using the formula SF=(geometric mean of brain counts)/(geometric mean of brain counts+geometric mean of lung counts), without dividing the geometric mean of brain counts by 0.13, although the brain is presumed to receive 13% of the cardiac output ( 2 ). Moreover, both LPS and CEE procedures were not described in sufficient detail.…”

Section: Dear Editormentioning

confidence: 99%

“…Apart from the patients’ characteristics, the diagnostic accuracy of LPS for identifying IPVDs can be affected by procedures and protocols. It should be noted that quantification with a technique that uses only brain uptake underestimates SF ( 2 ). In a recent prospective study, Zhao et al ( 2 ) compared the whole-body uptake and brain uptake techniques for calculating R-L shunt in 69 patients who received Tc-99m MAA in an upright position to maximize the degree of R-L shunt.…”

Section: Dear Editormentioning

confidence: 99%

“…It should be noted that quantification with a technique that uses only brain uptake underestimates SF ( 2 ). In a recent prospective study, Zhao et al ( 2 ) compared the whole-body uptake and brain uptake techniques for calculating R-L shunt in 69 patients who received Tc-99m MAA in an upright position to maximize the degree of R-L shunt. The study demonstrated that the whole-body uptake technique has a higher diagnostic accuracy than the brain uptake (74% versus 59%, respectively) for detecting IPVDs in HPS ( 2 ).…”

Section: Dear Editormentioning

confidence: 99%

“…In a recent prospective study, Zhao et al ( 2 ) compared the whole-body uptake and brain uptake techniques for calculating R-L shunt in 69 patients who received Tc-99m MAA in an upright position to maximize the degree of R-L shunt. The study demonstrated that the whole-body uptake technique has a higher diagnostic accuracy than the brain uptake (74% versus 59%, respectively) for detecting IPVDs in HPS ( 2 ). Furthermore, to the best of our knowledge, in all studies assessing patients with HPS, the diagnosis of IPVDs was based only on strict numerical values as expressed by the quantitative analysis, and no qualitative assessment of LPS was made.…”

Section: Dear Editormentioning

confidence: 99%

“…A visual scan interpretation demonstrated that the absence of brain parenchymal accumulation of Tc-99m MAA in a static image excluded the R-L shunt, and the specificity of a positive result was 100% ( 3 ). Quantitative brain imaging is characterized by a very high specificity and is extremely useful in patients with HPS and concomitant pulmonary diseases (30% of cases), severe and very severe HPS according to the arterial blood-gas analysis (PaO 2 <60 mmHg), and nondiagnostic CEE (approximately 7%) ( 2 , 4 , 5 ). Alternatively, although CEE is deemed as a sensitive screening test, it lacks specificity, as many cirrhotic patients with positive results on CEE have normal arterial blood-gas analysis and thus, by definition, have no HPS ( 4 ).…”

Section: Dear Editormentioning

confidence: 99%

See 4 more Smart Citations

Lung Perfusion Imaging with Technetium-99m Macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome

Meristoudis

Keramida

Ilias

2020

Mirt

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Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

See 3 more Smart Citations

Lung Perfusion Imaging with Technetium-99m Macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome

Meristoudis

Keramida

Ilias

2020

Mirt

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Hepatopulmonary Syndrome and Portopulmonary Hypertension: Pulmonary Vascular Complications of Liver Disease

Valle

DuBrock

2021

Comprehensive Physiology

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Pulmonary vascular disease is a frequent complication of chronic liver disease and portal hypertension, affecting up to 30% of patients. There are two distinct pulmonary vascular complications of liver disease: hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH). HPS affects 25% of patients with chronic liver disease and is characterized by intrapulmonary vasodilatation and abnormal arterial oxygenation. HPS negatively impacts quality of life and is associated with a 2-fold increased risk of death compared to controls with liver disease without HPS. Angiogenesis, endothelin-1 mediated endothelial dysfunction, monocyte influx, and alveolar type 2 cell dysfunction seem to play important roles in disease pathogenesis but there are currently no effective medical therapies. Fortunately, HPS resolves following liver transplant (LT) with improvements in hypoxemia. POPH is a subtype of pulmonary arterial hypertension (PAH) characterized by an elevated mean pulmonary arterial pressure and pulmonary vascular resistance in the setting of normal left-sided filling pressures. POPH affects 5% to 6% of patients with chronic liver disease. Although the pathogenesis has not been fully elucidated, endothelial dysfunction, inflammation, and estrogen signaling have been identified as key pathways involved in disease pathogenesis. POPH is typically treated with PAH targeted therapy and may also improve with liver transplantation in selected patients. This article highlights what is currently known regarding the diagnosis, management, pathobiology, and outcomes of HPS and POPH. Ongoing research is needed to improve understanding of the pathophysiology and outcomes of these distinct and often misunderstood pulmonary vascular complications of liver disease.

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Analogies and differences between cirrhotic cardiomyopathy and hepatopulmonary syndrome

Zardi

Giorgi²,

Dobrina

et al. 2020

Medicinal Research Reviews

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Cirrhotic cardiomyopathy and hepatopulmonary syndrome are two quite frequent clinical entities that may complicate the course of liver cirrhosis. The common pathophysiological origin and the same clinical presentation make them difficult to compare. Cirrhotic cardiomyopathy and hepatopulmonary syndrome may start with dyspnea and breathlessness but the former is characterized by a chronic cardiac dysfunction and the latter by a defect of oxygenation due to pulmonary shunts formation. The focus is to differentiate them as soon as possible since the treatment is different until the patient undergoes liver transplant that is the real unique cure for them.

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Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake

Cited by 10 publications

References 22 publications

Lung Perfusion Imaging with Technetium-99m Macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome

Lung Perfusion Imaging with Technetium-99m Macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome

Hepatopulmonary Syndrome and Portopulmonary Hypertension: Pulmonary Vascular Complications of Liver Disease

Analogies and differences between cirrhotic cardiomyopathy and hepatopulmonary syndrome

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