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

The aim of this study was to develop a new algorithm for volume determination by single photon emission computed tomography (SPECT). Different algorithms were evaluated through phantom studies. The results show that the algorithm combining moment-preserving bilevel thresholding and best-fit Laplacian second derivative edge detection can provide the most accurate measurement of volume. Besides, this method can be utilized in different SPECT systems with no need for further phantom studies. In patient studies, the results of liver volume calculation have indicated that this is a useful technique in clinical medicine.

Topics: Algorithms; Anatomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Models, Theoretical; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

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

Per-rectal portal scintigraphy with Tc-99m pertechnetate is a method to evaluate portosystemic shunting (shunt index) in inferior mesenteric vein. In this study the shunt index was estimated in patients with chronic liver disease in relation to the severity of liver injury, portal hypertension and incidence of oesophageal varices. Shunt index was elevated in patients with non-cirrhotic liver disease as compared with healthy normals (34 +/- 6% vs 8 +/- 2%; p < 0.0005). Moreover, patients with cirrhosis had the shunt index of 65 +/- 4% which was higher than in other groups. There was no correlation of the shunt index to the Child-Pugh classification, hepatic venous pressure gradient and varices size in the cirrhotic patients. Conversely, the shunt index differentiated variceal bleeders from non-bleeders (80 +/- 4% vx 59 +/- 6%; p < 0.005). These data show that peripheral collateral circulation develop in response to mild elevation of portal pressure, but its hemodynamic efficacy to alleviate portal hypertension seems to be unremarkable. High shunt index might reflect elevated risk of bleeding from varices.

Topics: Adult; Aged; Chronic Disease; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Hypertension, Portal; Liver Diseases; Male; Mesenteric Veins; Middle Aged; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m

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

We administered both per-rectal thallium-201 (201Tl) and technetium-99m pertechnetate (99mTc) to patients with liver diseases in order to understand the abnormalities of inferior mesenteric vein (IMV) blood flow circulation. As 201Tl heart-to-liver uptake ratio (H:L), reflecting the degree of portal-systemic shuntings (PSS), increased, the visualization of IMV in general became poor on 99mTc scintigrams. 201Tl H:L in the group with no visualization of IMV on 99mTc scintigrams was significantly higher than in the group with clear visualization of IMV (p less than 0.001). However, there were patients who showed IMV visualization among those with high 201Tl H:L. In these patients, it was considered that IMV blood flowed in the normograde direction, escaping mainly through PSS at the upper part of the portal system, and resulting in elevated H:L. In the patients without IMV visualization, IMV blood flowed in the retrograde direction, escaping mainly through collaterals at the lower part of IMV. Inferior vena cava (IVC) was visualized on 99mTc scintigrams in some patients without IMV visualization, indicating the presence of collaterals from the distal part of IMV to IVC. Per-rectal studies using these two radiotracers can afford us useful informations on the abnormalities of IMV blood flow hemodynamics in patients with liver diseases.

Topics: Adult; Aged; Female; Humans; Liver Diseases; Male; Mesenteric Veins; Middle Aged; Radionuclide Imaging; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes

Portal circulation in patients with liver diseases was evaluated by 99mTc-pertechnetate per-rectal portal scintigraphy, and we retrospectively examined the relationship between the extent of abnormality in the portal circulation and the development of esophageal varices. The per-rectal portal shunt index (PRPSI) was calculated for 13 healthy subjects and 79 patients with chronic hepatitis and 214 with cirrhosis of the liver. In the healthy subjects, the mean PRPSI was 4.8%. In the patients with hepatitis, the mean PRPSI was 8.4%, and in the patients with cirrhosis, it was 48.5%. The PRPSI was significantly higher in the cirrhotic patients with esophageal varices than in the without, and also in the cirrhotic patients with encephalopathy than in those without. The cumulative incidence of esophageal varices in the 3 years of the study in patients whose PRPSI was 20% or over was significantly higher than that in patients whose PRPSI was under 20%. The results suggested that this non-invasive method should be useful for predictions of the formation of esophageal varices.

Topics: Adult; Esophageal and Gastric Varices; Female; Humans; Liver Diseases; Male; Middle Aged; Portal System; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

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

To determine the accuracy of blood-pool imaging in the diagnosis of hepatic hemangiomas, 39 patients with various focal hepatic lesions were studied. The diagnoses in these patients were made by biopsy, angiography, surgical exploration, or clinical stability for a minimum of 14 months. The diagnoses were: hemangiomas (13 patients), hepatoma (three), metastases (19), abscesses (two), and liver cysts (two). After modified in vivo labeling of red blood cells with 20 mCi (740 MBq) of 99mTc pertechnetate, an initial flow study and early (1-15 min) and delayed (1-2 hr) static images were obtained. Increased blood-pool activity with a discordant flow pattern was seen in 11 of 13 patients with hemangiomas. False-negative scans occurred in two hemangiomas with extensive fibrosis. Two of three hepatomas had increased blood-pool activity associated with increased flow in a pattern identical to the increased blood-pool activity. None of the metastatic, abscess, or cystic lesions had increased blood-pool activity at any time after injection. It is concluded that 99mTc red blood cell imaging can distinguish hemangiomas from other focal liver lesions.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cysts; Diagnosis, Differential; Erythrocytes; Female; Hemangioma; Humans; Liver Abscess; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

The extraction efficiencies of the liver were studied in rabbits by injection in the portal vein of 99mTc-IDA and 131I-Rose Bengal in two experimental conditions. In the first experiment blood samples were collected for one minute from a catheter inserted into the vena cava with the tip at the sovrahepatic veins outflow level. The vena cava was ligated upperstream. In the second experiment blood was collected from the general circulation every other minute for 20' after administration. Control experiments were performed in rabbits by administration of 99mTc-Pertechnetate and 99mTc-Albumin. The results showed that the extraction of diethyl-IDA from the blood flowing through the liver is almost total.

Topics: Animals; Humans; Imino Acids; Iodine Radioisotopes; Kinetics; Liver; Liver Circulation; Liver Diseases; Male; Models, Biological; Rabbits; Radionuclide Imaging; Rose Bengal; Serum Albumin; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Diethyl-iminodiacetic Acid