sodium-pertechnetate-tc-99m and Liver-Cirrhosis

Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life.. A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case-control studies were included. The risk of bias was assessed.. Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Pre-fabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.. The sole Na. The SUV. Genetic variants of

Topics: AC133 Antigen; Acenaphthenes; Acer; Acrosome Reaction; Adult; Agaricales; Aged; Aged, 80 and over; Animals; Animals, Zoo; Anti-Bacterial Agents; Anticoagulants; Antifungal Agents; Antimanic Agents; Antioxidants; Aortic Valve; Area Under Curve; ATP Binding Cassette Transporter, Subfamily G, Member 2; Bacillus; Bacterial Toxins; Bacterial Typing Techniques; Base Composition; Beauveria; Binge Drinking; Biomarkers; Bipolar Disorder; Blood Coagulation; Blotting, Western; Brachytherapy; Calcium Channels, L-Type; Carcinoma, Non-Small-Cell Lung; Cell Cycle; Cell Line, Tumor; Cell Proliferation; Cell Survival; Cell Transformation, Neoplastic; Cell Wall; Cells, Cultured; Ceramics; Chi-Square Distribution; China; Chlorophyll; Chlorophyta; Chloroplasts; Cholesterol, HDL; Chromatography, High Pressure Liquid; Chromobacterium; Clostridium perfringens; Clozapine; Constriction, Pathologic; Coronary Artery Bypass; Corticotropin-Releasing Hormone; Cross-Sectional Studies; Cytochrome P-450 CYP2C9; Dental Porcelain; Dental Restoration Failure; Dental Stress Analysis; Designer Drugs; Diaminopimelic Acid; DNA Fingerprinting; DNA, Bacterial; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Drug Dosage Calculations; Drug Evaluation, Preclinical; Drug Resistance, Bacterial; Elasticity Imaging Techniques; Epsilonproteobacteria; Equipment Design; Ericaceae; Excitatory Amino Acid Antagonists; False Negative Reactions; Fatty Acids; Female; Food Analysis; Fresh Water; Gene Expression Regulation, Neoplastic; Glutathione; Graft Occlusion, Vascular; Heart Valve Prosthesis Implantation; Heart Ventricles; HEK293 Cells; Hemolymph; Humans; Hyaluronan Receptors; Hydrogen Peroxide; Hydrothermal Vents; Indoles; Inflammation Mediators; Inhibitory Concentration 50; Insecta; International Normalized Ratio; Isotope Labeling; Itraconazole; Kidney; Kinetics; Kruppel-Like Factor 4; Kruppel-Like Transcription Factors; Lamotrigine; Lanthanoid Series Elements; Limit of Detection; Linear Models; Lipid Peroxidation; Liver; Liver Cirrhosis; Logistic Models; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Malondialdehyde; Mediastinum; Metronidazole; Mice; Mice, Nude; Mice, Transgenic; Microbial Sensitivity Tests; Microscopy, Fluorescence; Middle Aged; Monocytes; Monomeric GTP-Binding Proteins; Multivariate Analysis; Myocytes, Cardiac; Neoplasm Staging; Neoplastic Stem Cells; Neural Pathways; Nitrates; Nucleic Acid Hybridization; Octamer Transcription Factor-3; Odds Ratio; Oxidation-Reduction; Oxidative Stress; Peptidoglycan; Phantoms, Imaging; Pharmacogenetics; Pharmacogenomic Variants; Phenotype; Phospholipids; Photolysis; Photosynthesis; Phylogeny; Plant Extracts; Polychaeta; Polymerase Chain Reaction; Polymorphism, Single Nucleotide; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Preoperative Care; Prostatic Neoplasms; Pseudomonas aeruginosa; Pyrimidines; Pyrroles; Quorum Sensing; Radiology, Interventional; Radiopharmaceuticals; Radiotherapy Dosage; Rats; Rats, Sprague-Dawley; Receptors, Corticotropin-Releasing Hormone; Reference Values; Regression Analysis; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Rhizosphere; Risk Factors; RNA, Ribosomal, 16S; ROC Curve; Rutin; Saphenous Vein; Seawater; Selenium; Semen Preservation; Sensitivity and Specificity; Septal Nuclei; Sequence Analysis, DNA; Serum Albumin; Serum Albumin, Human; Shear Strength; Sodium Pertechnetate Tc 99m; Sodium-Hydrogen Exchangers; Soil Microbiology; SOXB1 Transcription Factors; Spain; Species Specificity; Sperm Motility; Spermatozoa; Spheroids, Cellular; Spores, Fungal; Stroke; Superoxide Dismutase; Swine; Tandem Mass Spectrometry; Technetium Compounds; Technetium Tc 99m Exametazime; Technetium Tc 99m Sestamibi; Temperature; Thiosulfates; Thrombosis; Thyroid Neoplasms; Transducers; Transfection; Transplantation, Heterologous; Treatment Outcome; Triazines; Tumor Burden; Urocortins; Uterine Cervical Neoplasms; Vacuoles; Valproic Acid; Ventral Tegmental Area; Vitamin K 2; Vitamin K Epoxide Reductases; Warfarin; Water Microbiology; Young Adult

This randomized double-blind controlled study analyzed the hemodynamic effects of penbutolol, a new levo-rotatory betablocker, using radionuclide angiography. Twenty cirrhotics with esophageal varices were randomized: 10 received 40 mg/day of penbutolol orally and the others a placebo. Angioscintigraphy was performed before and after an 8-day treatment period. Three cases in the penbutolol group were lost due to software damage, hence the data of 17 patients were analyzed. The two groups were similar for age, sex, etiology of cirrhosis and hepatic function. The index of portal perfusion decreased significantly (-29%; p = 0.018), and the hepatic artery index increased significantly (+23%; p = 0.018), whereas no changes were observed after placebo. The heart rate decreased significantly after penbutolol (-9%; p = 0.021); while neither penbutolol nor placebo modified the ejection fraction. In conclusion, penbutolol decreased portal perfusion index (the compensatory increase of hepatic artery index confirmed this change) without significant modification of total hepatic blood flow and systemic hemodynamics. Angioscintigraphy is reasonably accurate, reproducible, safe and can be considered suitable for routine use in the assessment of liver hemodynamics.

Topics: Administration, Oral; Double-Blind Method; Hemodynamics; Humans; Hypertension, Portal; Liver; Liver Circulation; Liver Cirrhosis; Penbutolol; Radionuclide Angiography; Sodium Pertechnetate Tc 99m

To assess the potential utility of an integrin αvβ3-targeting radiotracer, technetium 99m-PEG4-E[PEG4-cyclo(arginine-glycine-aspartic acid-D-phenylalanine-lysine)]2 ((99m)Tc-3PRGD2), for single photon emission computed tomography (SPECT)/computed tomography (CT) for monitoring of the progression and prognosis of liver fibrosis in a rat model.. All animal experiments were performed by following the protocol approved by the institutional animal care and use committee. (99m)Tc-3PRGD2 was prepared and longitudinal SPECT/CT was performed to monitor the progression (n = 8) and recovery (n = 5) of liver fibrosis induced in a rat model by means of thioacetamide (TAA) administration. The mean liver-to-background radioactivity per unit volume ratio was analyzed for comparisons between the TAA and control (saline) groups at different stages of liver fibrosis. Data were compared by using Student t and Mann-Whitney tests. Results:of SPECT/CT were compared with those of ex vivo biodistribution analysis (n = 5).. Accumulation of (99m)Tc-3PRGD2 in the liver increased in proportion to the progression of fibrosis and TAA exposure time; accumulation levels were significantly different between the TAA and control groups as early as week 4 of TAA administration (liver-to-background ratio: 32.30 ± 3.39 vs 19.01 ± 3.31; P = .0002). Results of ex vivo immunofluorescence staining demonstrated the positive expression of integrin αvβ3 on the activated hepatic stellate cells, and the integrin αvβ3 levels in the liver corresponded to the results of SPECT/CT (R(2) = 0.75, P < .0001). (99m)Tc-3PRGD2 uptake in the fibrotic liver decreased after antifibrotic therapy with interferon α2b compared with that in the control group (relative liver-to-background ratio: 0.45 ± 0.05 vs 1.01 ± 0.05; P < .0001) or spontaneous recovery (relative liver-to-background ratio: 0.56 ± 0.06 vs 1.01 ± 0.05; P < .0001).. (99m)Tc-3PRGD2 SPECT/CT was successfully used to monitor the progression and recovery of liver fibrosis and shows potential applications for noninvasive diagnosis of early stage liver fibrosis.

Topics: Animals; Disease Models, Animal; Imaging, Three-Dimensional; Integrin alphaVbeta3; Liver Cirrhosis; Male; Multimodal Imaging; Radiopharmaceuticals; Rats; Rats, Wistar; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Tomography, Spiral Computed

To investigate potential roles of per rectal portal scintigraphy in diagnosis of esophageal varices and predicting the risk of bleeding.. Fifteen normal subjects and fifty cirrhotic patients with endoscopically confirmed esophageal varices were included. Patients were categorized into bleeder and non-bleeder groups according to history of variceal bleeding. All had completed per rectal portal scintigraphy using (99m)Technetium pertechnetate. The shunt index was calculated from the ratio of (99m)Technetium pertechnetate in the heart and the liver. Data were analyzed using Student's t-test and receiver operating characteristics.. Cirrhotic patients showed a higher shunt index than normal subjects (63.80 +/- 25.21 vs 13.54 +/- 6.46, P < 0.01). Patients with variceal bleeding showed a higher shunt index than those without bleeding (78.45 +/- 9.40 vs 49.35 +/- 27.72, P < 0.01). A shunt index of over 20% indicated the presence of varices and that of over 60% indicated the risk of variceal bleeding.. In cirrhotic patients, per rectal portal scintigraphy is a clinically useful test for identifying esophageal varices and risk of variceal bleeding.

Topics: Adolescent; Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Portal System; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Risk Factors; Sodium Pertechnetate Tc 99m

Variceal haemorrhage is a potentially life-threatening complication in cirrhotic patients. Identification of patients at high risk for bleeding is particularly important. The aim of this study was to determine the clinical usefulness of per-rectal portal scintigraphy (PPS) in the evaluation of the severity of portal hypertension in cirrhotic patients, in terms of correlation between cirrhosis and the parameters of hepatic functional reserve, and identifying the difference of the portal shunt index (PSI) of the bleeding oesophageal variceal (BEV) patients and non-BEV patients.. Portal circulations in 67 patients with cirrhosis and oesophageal varices were evaluated by Tc-99m pertechnetate PPS. Tc-99m pertechnetate (550 MBq) was instilled into the upper rectum, and dynamic images of upper abdomen were taken. Radioactivity curves for the liver and the heart were generated sequentially. Through the analysis of these curves, the PSI was determined.. The results, expressed as PSI, were: 11.4 +/- 98.4 percent (mean 66.8) in all 67 cirrhotic patients, 56.4 +/- 27.1 percent in cirrhotic patients without history of BEV, and 74.9 +/- 13.6 percent in cirrhotic patients with history of BEV. The PSI was significantly lower in cirrhotic patients without BEV than those with BEV (p-value equals 0.001). The PSI calculated with this method was correlated with the serum albumin, the serum bilirubin, the prothrombin time, and the Child-Turcotte-Pugh score.. Tc-99m pertechnetate PPS has clinical usefulness as a noninvasive method of choice for quantitatively evaluating the severity of portal hypertension in cirrhotic patients.

Topics: Administration, Rectal; Adult; Cohort Studies; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Function Tests; Male; Middle Aged; Portasystemic Shunt, Surgical; Probability; Radionuclide Imaging; Radiopharmaceuticals; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sodium Pertechnetate Tc 99m

Impaired exercise capacity and oxygen consumption are common in cirrhosis.. To explore the relationship between possible myocardial dysfunction and exercise tolerance in cirrhosis.. Cardiac responses to exercise, using radionuclide angiography and graded upright cycle ergometry with oxygen consumption, were assessed before and after exercise in 39 cirrhotics patients and compared with 12 age and sex matched healthy volunteers. Baseline cardiac chamber dimensions and wall thickness, ejection fraction, and diastolic function were measured using two dimensional echocardiography is all subjects.. Baseline diastolic dysfunction with prolonged isovolumic relaxation times (p=0.02), left atrial enlargement, and left ventricular wall thickening were present in all cirrhotics (p=0.02), despite increased mean ejection fraction. With graded exercise, cirrhotics achieved 71 (4)% (p=0.03) (pre-ascitics) and 46 (3)% (p<0.001) (ascitics) of predicted work loads, respectively, without significant increases in ejection fraction. The smaller absolute and percentage increases in cardiac output (p=0.003) in the cirrhotics were associated with significantly reduced oxygen consumption (p=0.003) and anaerobic threshold (p<0.001), and correlated significantly with work and metabolic parameters.. Impaired exercise capacity in cirrhosis is associated with myocardial thickening and ventricular stiffness leading to decreased diastolic function, inotropic and chronotropic incompetence under conditions of stress, with metabolic consequences. This picture is compatible with the condition now known as cirrhotic cardiomyopathy.

Topics: Analysis of Variance; Ascites; Cardiomyopathies; Case-Control Studies; Echocardiography; Exercise Test; Exercise Tolerance; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Oxygen Consumption; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Sodium Pertechnetate Tc 99m; Stroke Volume

We performed positron emission tomography with 15O water (H2(15)O) to measure hepatic arterial and portal blood flow. In addition, portal haemodynamics and hepatic functional reserve were measured by per-rectal portal scintigraphy and scintigraphy with galactosyl human serum albumin, respectively. We studied 15 patients who had cirrhosis of the liver with underlying viral infection. After the intravenous injection of H2(15)O, positron emission tomography was performed. Blood samples were obtained after beginning the emission scan. The blood samples and positron emission tomographic images were analysed to calculate the radioactivity in the blood and liver. One-compartment model analysis was used to estimate hepatic arterial and portal blood flow. Computer acquisition of gamma-camera data was started just before the injection of 99Tc(m)-galactosyl human serum albumin. A receptor index and an index of blood clearance were calculated on the basis of the radioactivity of the liver and heart. A 99Tc(m)-pertechnetate solution was instilled into the rectum; serial scintigrams were performed and radioactivity curves for the liver and heart were recorded sequentially. A per-rectal portal shunt index was calculated from the curves. Median portal blood flow was 80 ml x 100 g(-1) x min(-1), median hepatic arterial blood flow was 56 ml x 100 g(-1) x min(-1), and median total hepatic blood flow was 138 ml x 100 g(-1) x min(-1) in patients with cirrhosis. The correlations between portal blood flow and the Child-Turcotte classification score, portal shunt index and receptor index were all significant. Our results show that hepatic arterial and portal blood flow can be measured by positron emission tomography with H2(15)O non-invasively and physiologically. This technique may be useful in pathophysiological studies of liver disease.

Topics: Hepatitis, Viral, Human; Humans; Liver; Liver Circulation; Liver Cirrhosis; Metabolic Clearance Rate; Oxygen Radioisotopes; Portal System; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Regression Analysis; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate; Tomography, Emission-Computed; Water

Portal circulation can be evaluated in a relatively noninvasive way by per-rectal portal scintigraphy. We used this method to evaluate portal hemodynamics in patients with chronic liver diseases and underlying hepatic viral infection; the patients did not need surgery or sclerotherapy, or refused it, so changes in the natural course were identified. A solution of Tc-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were produced. The per-rectal portal shunt index was calculated from the curves. In a longitudinal study, 70 patients (9 with mild chronic hepatitis, 10 with moderate chronic hepatitis, 7 with severe chronic hepatitis, 22 with cirrhosis but without varices, and 22 with both cirrhosis and varices) were examined at least twice at intervals of 12-102 months (mean, 39 months). The shunt index was higher for more severe disorders, increasing in the order of mild chronic hepatitis, moderate chronic hepatitis, severe chronic hepatitis, cirrhosis without varices, and cirrhosis with varices. The mean annual changes in the mean shunt index were 1.0% in mild chronic hepatitis, 4.4% in moderate chronic hepatitis, 6.1% in severe chronic hepatitis, 10.7% in cirrhosis without varices, and 6.2% in cirrhosis and varices. Cirrhotic patients were arbitrarily divided into two groups of roughly equal size on the basis of the shunt index at the first examination. In those with a shunt index of 30% or more, the mean annual change was 4.7%. The patients with a shunt index of less than 30% had a mean annual change of 11.8%. Changes in the portal hemodynamics were not steady. The shunt index rose gradually as disease advanced from mild to moderate and to severe chronic hepatitis and cirrhosis of the liver, after which the index rose rapidly when varices developed, slowing later.

Topics: Cross-Sectional Studies; Female; Hepatitis, Chronic; Humans; Liver Circulation; Liver Cirrhosis; Longitudinal Studies; Male; Middle Aged; Portal Vein; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Sodium Pertechnetate Tc 99m; Time Factors

The intrahepatic distribution of radioactivity after the per-rectal administration of 201T-chloride and/or 99Tcm-pertechnetate was investigated in 177 studies in 149 patients with no liver disease or diffuse liver disease and compared with that of 99Tcm-stannous (99Tcm-Sn) colloid scintigrams. The patients were classified into two groups: distribution of intrahepatic radioactivity of 201Tl and/or 99Tcm-pertechnetate scintigrams similar to (homogeneous) or different from (heterogeneous) that of 99Tcm-Sn-colloid scintigrams. The heterogeneous group was divided into three subgroups: increased radioactivity of the right lobe (right dominant pattern), increased radioactivity of the left lobe (left dominant pattern) and uneven distribution of radioactivity in both lobes (uneven pattern). Of the 80 patients in whom the studies were performed in the supine position at rest, 14 (17.5%) showed a heterogeneous pattern (8 right dominant, 4 left dominant, 2 uneven) and 66 (82.5%) a homogeneous pattern. In the 97 patients allowed free body movement, 6 (6.2%) showed a heterogeneous (1 right dominant, 5 left dominant) and 91 (93.8%) a homogeneous pattern. A significant difference in the incidence of heterogeneous distribution between the resting and free body movement groups was found (P < 0.05). One patient with a left dominant pattern after free body movement with 201Tl showed a right dominant pattern at rest in the 99Tcm-pertechnetate study. It is concluded that a heterogeneous intrahepatic distribution of inferior mesenteric vein blood is sometimes observed and that the distribution of portal vein blood flow seems to be affected by the patient's positioning and free body movement.

Topics: Administration, Rectal; Hepatitis; Humans; Liver Circulation; Liver Cirrhosis; Liver Diseases; Mesenteric Veins; Movement; Portal System; Portal Vein; Posture; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Compounds; Thallium; Tin Compounds

Portal circulation, in particular the contribution of the inferior mesenteric vein, can be evaluated in a relatively noninvasive way by per rectal portal scintigraphy (J Nucl Med 1988; 29:460-5). The clinical usefulness of the method was evaluated.. A solution containing technitium-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were recorded sequentially. By analyses of the curves, the per rectal portal shunt index (SI) was calculated.. The SI was higher for disorders that were more severe, increasing in the order of chronic persistent hepatitis, chronic aggressive hepatitis, and cirrhosis, and the SI was higher in cirrhotic patients than in patients with chronic hepatitis or in healthy subjects. The SI was significantly higher when a complication (varices, ascites, or encephalopathy) was present. Correlation between the SI and classic indicators for functional reserve was significant. The SI was significantly related to survival according to results of regression analysis by Cox's proportional hazards model. On the basis of the SI when patients were first examined, the patients with cirrhosis were divided into three groups of roughly equal size: group A, SI under 30%; group B, SI between 30 and 70%; and group C, SI over 70%. The survival rate was lower in group B than in A, lower in group C than in A, and lower in group C than in B.. This method is clinically useful, especially in establishing the prognosis.

Topics: Humans; Hypertension, Portal; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Portal System; Prognosis; Proportional Hazards Models; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Survival Rate

Propranolol can reduce portal hypertension, therefore is recommended in prevention of variceal bleeding in patients with liver cirrhosis. However, in certain patients with cirrhosis portal hypotensive effect of propranolol cannot be obtained, and the reason of this finding is unknown. In 28 patients with cirrhosis the effect of seven days administration of propranolol on collateral blood flow from inferior mesenteric vein was examined by means of per-rectal portal scintigraphy. Portosystemic shunt index was significantly reduced by propranolol by 17.4 +/- 4.8%. This reduction was observed in cirrhotics classified to A and B, but not C Child-Pugh. These data suggest that propranolol increases vascular resistance in portosystemic circulation which depends on severity of liver failure. This mechanism opposes reduction of portal pressure.

Topics: Adult; Aged; Blood Pressure; Collateral Circulation; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Middle Aged; Portal System; Propranolol; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Vascular Resistance

We evaluated the role of per-rectal portal scintigraphy with 99m-technetium pertechnetate (99m-Tc test) for early diagnosis of cirrhosis. Forty patients with biochemical evidence of chronic liver disease were studied. Laparobiopsy documented chronic active hepatitis (CAH) without cirrhosis in 22 of the patients and CAH with cirrhosis (CAHc) in 18 patients. Clinical or laboratory findings could not differentiate between CAH and CAHc. Twelve healthy volunteers served as controls. The results, expressed as shunt index (SI), i.e., the ratio between heart radioactivity and the sum of heart and liver radioactivity in the first 30 s of observation, were: controls 5.66 +/- 1.66, CAH 15.27 +/- 2.83 and CAHc 24.88 +/- 3.95. A significant difference between the mean SI values in the three groups studied (F = 142.71, p less than 0.0001) was observed. At values less than 17, our test showed a predictivity of 100% for cirrhosis exclusion, while at values higher than 19 the predictive positive value for a diagnosis of cirrhosis was 100%. Invasive diagnostic procedures should be performed only in patients with SI values between 17-19.

Topics: Adult; Female; Hepatitis; Hepatitis B; Hepatitis C; Humans; Liver Cirrhosis; Liver Function Tests; Male; Portal System; Radionuclide Imaging; Reference Values; Sodium Pertechnetate Tc 99m

Mean transit time (MTT) through a given vascular space is closely related to the effective blood volume in this compartment. Central vascular blood volume in liver cirrhosis is believed to be reduced, but more precise data on the location of the underfilled vascular area are lacking. 99mTechnetium first-pass angiography was performed in 15 cirrhotic patients and in 10 age-matched normals. The method of segmental analysis of MTT was validated by performing an analog study in a plastic tubing/chamber system. The mean tracer sojourn in the central circulation was described in cirrhotic patients (10.25 +/- 2.17 s vs 12.92 +/- 2.88 s; p less than 0.05); however, this finding was not observed beyond cardiopulmonary circulation (MTT between right and left heart chambers). Segmental comparative analysis between cirrhotics and normals revealed significant MTT differences in two vascular subcompartments, i.e. right chamber-pulmonary artery, and within the lung vascular bed. Analysis of time activity lung curves in patients with cirrhosis disclosed a shorter time to peak and more rapid washout of the tracer from this area, without any change in curve symmetry as compared to normals. Ascites had no apparent impact on MTT rate, and cirrhotics with most advanced disease (grade C Child-Pugh) had longer MTT through the cardiopulmonary circulation as compared to combined groups A & B (7.32 +/- 0.13 s vs 6.03 +/- 1.23 s; p less than 0.05). Our data provide further evidence for contraction of the cardiopulmonary vascular space in liver cirrhosis.

Topics: Blood Volume; Female; Heart; Humans; Liver Cirrhosis; Lung; Male; Middle Aged; Models, Cardiovascular; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Splanchnic Circulation

Portal circulation in patients with chronic liver diseases was evaluated by [99mTc]pertechnetate per-rectal scintigraphy. Technetium-99m pertechnetate (10 mCi) was instilled into the upper rectum, and serial scintigrams were taken. Radioactivity curves for the liver and heart were then recorded sequentially. Through analysis of these curves, the per-rectal portal shunt index (Sl) was calculated for six healthy subjects and 228 patients, 59 with chronic hepatitis, seven with idiopathic portal hypertension, six with primary biliary cirrhosis, and 156 with cirrhosis. In the healthy subjects, the Sl was 1.9-5.2% (mean 4.1%). In hepatitis, the mean Sl was 7.1%, and in cirrhosis, 52.9%. The Sl was higher in cirrhotic patients with esophageal varices than in those without (p less than 0.001), and in cirrhotic patients with encephalopathy than in those without (p less than 0.01). For some patients with portal hypertension, portal collateral circulation could be depicted, and images of changes in the portal collateral circulation after vascular anastomosis were seen.

Topics: Administration, Rectal; Adult; Chronic Disease; Collateral Circulation; Esophageal and Gastric Varices; Female; Heart; Hepatitis; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Liver Cirrhosis, Biliary; Liver Diseases; Methods; Middle Aged; Portal System; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Vena Cava, Inferior

Dynamic hepatic scintigraphy was performed in 49 patients with established cirrhosis, using intravenous 99Tcm-pertechnetate and 99Tcm-sulphur colloid in a prospective study of its predictive value. There was a close correlation between the hepatic perfusion index (reflecting the ratio of arterial to total hepatic blood flow) obtained with pertechnetate (HPI-P) and with sulphur colloid (HPI-C) (r = 0.775; p less than 0.0001), and both indices correlated with disease severity (HPI-P p less than 0.0001; HPI-C p less than 0.01). HPI-P was significantly increased in patients who died, in patients with varices and in those with hepatic encephalopathy. HPI-C was significantly increased in patients with varices, in patients with hepatic encephalopathy and in those who had bled from varices. Neither HPI-P nor HPI-C was able accurately to predict the development of complications during the follow-up period. The trapping index (TI), reflecting a combination of hepatic extraction efficiency, degree of intrahepatic shunting and extrahepatic extraction of colloid, was significantly impaired in patients who died and in those with ascites, varices and/or variceal bleeding, but not in patients with hepatic encephalopathy. The trapping index correlated with disease severity, as did the computer-derived spleen-liver ratio (S-L ratio). Neither TI nor S-L ratio was able to predict the development of complications. The clearance rate constant of colloid from peripheral blood, the uptake rate constants for liver and spleen, and splenic volume were all found to be unhelpful as indicators of disease severity or as predictors of complications. While perfusion indices derived by dynamic hepatic scintigraphy reflect the severity of the underlying liver disease, their determination on a single occasion appears to offer no benefit in predicting the likelihood of major complications.

Topics: Adult; Aged; Female; Humans; Liver; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Age Factors; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Liver Circulation; Liver Cirrhosis; Liver Function Tests; Male; Sodium Pertechnetate Tc 99m

The measurement of portal venous flow to the liver is important in the evaluation of patients for shunt surgery. A previous report described a method using slope analysis of hepatic radionuclide angiograms to generate an index of relative portal flow, which correlated well with angiographic grades of portal perfusion. The present report describes a refinement in bolus administration and a modification in technique that appear to reflect true portal venous flow more accurately. A total of 109 studies was performed, including seven normal and 80 cirrhotic patients. The method was reproducible (r = 0.998) and showed good correlation with the angiographic grades of perfusion (r = -0.906).

Topics: Humans; Liver Circulation; Liver Cirrhosis; Portal Vein; Postoperative Care; Preoperative Care; Radiography; Sodium Pertechnetate Tc 99m; Technetium; Tomography, Emission-Computed

Scintisplenoportography was performed on 33 occasions in 28 cirrhotic patients who had bled from esophagogastric varices. In 17 cases scintisplenoportography was carried out after a retroperitoneal distal splenorenal shunt procedure and in the remaining 16 instances in patients without any surgical shunt. In four patients scintisplenoportography was performed before and after a surgical shunt procedure, and in one case, before and after the shunt thrombosed. Gammagraphic patterns and spleen-heart times helped determine which patients did not have a surgical shunt, which had a patent shunt, and which patients had a thrombosed shunt. A patent shunt pattern and a thrombosed shunt pattern have been defined. It is concluded that scintisplenoportography is a useful, reproducible, and safe method to assess the patency of distal splenorenal shunts.

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Circulation; Liver Cirrhosis; Portasystemic Shunt, Surgical; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Splenorenal Shunt, Surgical; Technetium; Thrombosis; Time Factors

Radionuclide angiography was used to generate first-pass radioactivity vs. time curves for the left heart, right hepatic lobe, right lung, spleen, and both kidneys following rapid intravenous injection of 20 mCi (740 MBq) of 99mTc-pertechnetate. Seven normal subjects were examined as well as 57 cirrhotic patients, who also underwent angiographic grading of portal venous perfusion. For analysis, two time points were identified: (a) t0, when 99mTc first entered the liver (the initial rise of either curve); and (b)tc, when 99mTc was maximal in abdominal organs (the renal peak). Analysis was based on the slopes of the two phases of the hepatic curves t0 + 7 seconds and Tc + 7 seconds; this time selection permitted analysis of all curves. The hepatic perfusion index (HPI) = slope (tc + 7 secs)/slope (t0 + 7 secs) + slope (tc + 7 secs). The mean HPI for the normal subjects was 66% +/- 7; for the cirrhotic patients with angiographic Grades I, II, III, and IV, the HPI was 52% +/- 9, 37% +/- 6, 15% +/- 7, and 3% +/- 4, respectively. Correlation between HPI and angiography was significant (p less than 0.001). This method offers a readily available, rapid, relatively inexpensive, and quantitative method of grading the ratio of portal venous to total hepatic blood flow.

Topics: Adult; Female; Humans; Liver; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Portal Vein; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spleen; Technetium; Time Factors