sodium-pertechnetate-tc-99m and Cholestasis

We evaluated the clinical usefulness of 99mTc-pertechnetate per-rectal portal scintigraphy (PPS) in the assessment of portal circulation in children with chronic cholestasis.. PPS percentage shunt index (%SI) (the amount of radionuclide that shunts the liver and reaches the systemic blood after injection in the rectum) was measured in 22 children (mean age, 7.2 +/- 4.9 y) and compared with established clinical, laboratory, and endoscopic and imaging parameters of portal hypertension (PH). Fourteen children had surgically treated biliary atresia, and 8 had chronic intrahepatic cholestasis. Six clinically well children served as control subjects.. The %SI was 14.3 +/- 3.1 and 34.7 +/- 18.8 in controls and in patients, respectively (P < 0.01). A cutoff of 19% correctly allocated 100% of controls and 86% of patients. Mean %SI values were significantly higher in patients with biliary atresia, a high risk of pretransplantation death, esophageal varices (EV) at endoscopy, and an abnormal value for the ratio of lesser omentum thickness to abdominal aorta diameter (LO/Ao) at ultrasonography. Correlations between %SI values and several ultrasonographic continuous variables were statistically significant only for LO/Ao ratios (r = 0.51; P = 0.005) and spleen longitudinal diameters (r = 0.53; P = 0.01). The presence of EV could correctly be predicted only when values of %SI were greater than 30% (100% specificity; 56% sensitivity). Endoscopic and PPS findings agreed for a diagnosis of PH with EV in 3 of 7 patients with normal or borderline ultrasonographic LO/Ao ratios. PPS patterns and %SI values became normal in 3 children who underwent liver transplantation.. In children with chronic cholestasis, PPS may be an advantageous, minimally invasive tool complementary to ultrasonography and endoscopy for better assessment and follow-up of PH before and after liver transplantation.

Topics: Adolescent; Child; Child, Preschool; Cholestasis; Chronic Disease; Endoscopy, Digestive System; Female; Humans; Hypertension, Portal; Infant; Male; Portal System; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Ultrasonography

Topics: Bile; Cholestasis; Humans; Hypertension, Portal; Imino Acids; Liver Circulation; Liver Diseases; Organotechnetium Compounds; Portal System; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Lidofenin