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

摘要

AIM: To explore portal hypertension and portosys-temic shunts and to stage chronic liver disease (CLD) based on the pathophysiology of portal hemodynam-ics. METHODS: Per-rectal portal scintigraphy (PRPS) was performed on 312 patients with CLD and liver angio-scintigraphy (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 in? ow. 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. Abnor-mal LTT had PPV = 100% for CLD. Twenty-seven non-cirrhotic 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 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the clas-sifi cation of CLD in 5 hemodynamic stages. Stage 0 is normal (LTT = 24 s,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 por-tal 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.