technetium-tc-99m-sulfur-colloid and Liver-Cirrhosis--Alcoholic

Topics: Aged; Aged, 80 and over; Ascites; Humans; Hydrothorax; Liver Cirrhosis, Alcoholic; Male; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

A prospective study of 101 consecutive patients of portal hypertension was carried out to study the possible relationships between bone marrow activity on 99m technetium labelled sulphocolloid scan and severity of liver disease, etiology of portal hypertension and cirrhosis, as well as presence and extent of collateral circulation, including esophageal varices. The patients were divided into 4 etiological groups: alcoholic cirrhosis (ALD), (38) non-alcoholic cirrhosis (NALD) (35) non-cirrhotic portal fibrosis (NCPF) (14) and extrahepatic portal vein obstruction (EHPVO) (14). Patients of cirrhosis were categorised according to modified Child-Pugh's classification. Esophageal varices were graded endoscopically as (1) no varix (2) small varices (< 5mm) (3) large varices (> 5mm). All patients underwent radionuclide imaging using 99m Technetium labelled sulphocolloid and bone marrow activity was studied. Evaluation of portasystemic collaterals was done ultrasonically. We found that 16.6%, 44.6% and 72.72% patients with Child A, B and C cirrhosis respectively, had increased marrow activity (p < 0.05). There was no significant difference between marrow activity of patients with ALD (52.6%) and NALD (40%). None of the non-cirrhotic patients demonstrated bone marrow uptake of radioisotope. There was no significant difference between bone marrow uptake presence of lienorenal collaterals and presence or size of esophageal varices. We thus conclude the bone marrow activity on radioisotope scanning depends only on the severity of liver disease and does not vary a according to the etiology of cirrhosis, or presence and extent of portasystemic collaterals, including esophageal varices.

Topics: Adult; Bone Marrow; Case-Control Studies; Collateral Circulation; Esophageal and Gastric Varices; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Male; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Topics: Hepatitis B; Hepatitis B Surface Antigens; Hepatitis, Chronic; Humans; Liver Cirrhosis, Alcoholic; Liver Diseases; Radionuclide Imaging; Splenomegaly; Technetium Tc 99m Sulfur Colloid

Various criteria are used together for the scintigraphic diagnosis of cirrhosis as no single criterion may be reliable. However, low right-to-left hepatic lobe uptake ratio has been reported to be sensitive and specific for alcoholic cirrhosis. A low liver-to-spleen uptake ratio has also been reported in various hepatocellular disorders. We tested these ratios in patients with cirrhosis and non cirrhotic causes of portal hypertension. The right-to-left lobe uptake ratio was significantly lower (1.59 +/- 1.23 vs 2.36 +/- 0.63 in normals; p = 0.037) in only Child's C alcoholic cirrhosis, but the sensitivity of this ratio was low (40%) even in this subgroup of cirrhosis (mean +/- SD 1.72 +/- 1.08) as against 1 of 10 patients with non cirrhotic portal hypertension (3.57 +/- 1.33; p = 0.0005). We conclude that the right-to-left hepatic lobe uptake ratio is not a discriminatory scintigraphic sign in liver disease. A low liver-to-spleen uptake ratio can distinguish cirrhosis from non cirrhotic causes of portal hypertension.

Topics: Diagnosis, Differential; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Sensitivity and Specificity; Spleen; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

A 54-yr-old female with known liver cirrhosis presented with a right transudative pleural effusion and ascites. To find the source of pleural fluid, [99mTc]sulfur colloid was injected intraperitoneally and a serial imaging study revealed its passage to the right pleural space on 2-hr and 24-hr images. Mechanisms proposed in the formation of pleural effusion in liver cirrhosis are (a) lymphatic drainage and (b) diaphragmatic defect. Radioisotope migration speed may be a clue for differentiating these two mechanisms, being more rapid in the presence of a diaphragmatic defect.

Topics: Ascites; Female; Fistula; Humans; Liver Cirrhosis, Alcoholic; Middle Aged; Peritoneal Diseases; Pleural Diseases; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Two cases of right hepatic hydrothorax occurring in the absence of clinical ascites are reported. Diagnosis was confirmed by the intraperitoneal and intrapleural injection of radioisotope 99mTc-sulfur colloid that demonstrated the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavities. In contrast, radioisotope injected into the peritoneal cavity of 5 patients with pleural effusions secondary to pulmonary or cardiac disease failed to traverse the diaphragm and localize in the pleural space. Medical therapy with salt and water restriction and diuretics resulted in both of the patients with hepatic hydrothorax developing signs of intravascular volume depletion without significant mobilization of the pleural fluid. Thoracotomy allowed identification of the diaphragmatic defects that were repaired by chemical and traumatic pleurodesis followed by postoperative peritoneal and pleural drainage. This therapy resulted in complete resolution of the pleural effusions, which have not recurred despite the subsequent development of clinical ascites in both patients.

Topics: Ascitic Fluid; Female; Hepatitis, Alcoholic; Hepatitis, Chronic; Humans; Hydrothorax; Liver Cirrhosis, Alcoholic; Middle Aged; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The radiocolloid liver-spleen scintigrams of seven patients with advanced cirrhosis of the liver were correlated with autopsy results. The data showed scintigraphic overestimation of splenic size and underestimation of hepatic size. The causes of underestimation of the liver size were: rotation of the liver due to ascites; photon attenuation by ascitic fluid; and/or decreased and in homogeneous distribution of radiocolloid in the diseased liver. The splenic size/weight was overestimated because of lack of the effects of ascites and the usually marked increase in splenic radioactivity. Awareness of the underestimation of the liver weight/size and overestimation of the splenic weight/size occurring on the radiocolloid liver-spleen scan of patient with advanced alcoholic cirrhosis of the liver may help avoid misinterpretation.

Topics: Aged; Humans; Liver; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

Scintigraphic evidence of ascites has been observed in Tc-99m sulfur colloid studies of the liver and spleen, in Tc-99m HIDA hepatobiliary scans, in Ga-67 citrate scans, and in Tc-99m phosphonate bone images. Pleural effusion has been demonstrated in Tc-99m phosphonate bone scintigraphy. The case of a 48-year-old man whose Tc-99m sulfur colloid liver-spleen scintigram simultaneously demonstrated a right pleural effusion and ascites is presented.

Topics: Ascites; Humans; Liver; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Pleural Effusion; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

The anterior view of a liver-spleen scintigram performed with Tc-99m sulfur colloid was used to calculate the right-to-left (R/L) hepatic lobe ratio in three patients (acute hepatitis, normal, alcoholic cirrhosis). Emission computed tomography (ECT) was also performed, and the images correlated with the data obtained from the planar images. A low R/L hepatic lobe ratio correctly identified the patient with alcoholic cirrhosis. Streamlining of ethanol to the right (R) lobe of the liver has been suggested as the principal reason why the R/L hepatic ratio is decreased in alcoholic cirrhosis. The evaluation of the ECT images, however, suggest that the count density in each lobe of the liver is similar in the patient with alcoholic cirrhosis. The latter and known information regarding the absorption of ethanol from the gastrointestinal tract are not in agreement with the alcohol streamlining theory.

Topics: Adult; Ethanol; Female; Hepatitis; Humans; Intestinal Absorption; Liver; Liver Circulation; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Portal System; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Six patients with decompensated cirrhosis of the liver underwent Tc-99m BIDA studies. All demonstrated 1) persistently high blood pool activity in the heart, lung, and soft tissue, 2) slow hepatic tracer uptake, 3) prolonged liver-to-bowel transit time, and 4) visualization of an enlarged spleen. Four of the six patients demonstrated evidence of ascites and in one patient there were visible collateral veins of the abdomen. These findings are due primarily to hepatic dysfunction and retaining Tc-99m BIDA in blood pool because of Tc-99m BIDA exclusively hepatic excretion and little or no alternative renal excretion. All six Tc-99m sulfur colloid studies were performed concomitantly. Except for bone marrow uptake and reversal of the normal liver-spleen ratio of radioactivity, the imaging abnormalities observed with Tc-99m BIDA were similar to those seen by Tc-99m SC. It is concluded that with Tc-99m BIDA studies, three of six abnormal findings, as described, suggest a decompensated stage of cirrhosis of the liver.

Topics: Humans; Imino Acids; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

The mechanism of liver scan abnormality was investigated in patients with acute alcoholic liver injury evaluated shortly after admission (18 patients) with repeat examination 1 month later (14 patients). Indocyanine green (ICG) and Tc99 sulfur colloid extraction ratios (ERICG and ERSC), elimination rate constants (KICG and KSC), total body clearance (TBCICG and TBCSC), and hepatic clearance of sulfur colloid (HCSC) were determined from sequential blood samples obtained at the time of hepatic vein catheterization after the intravenous injection of ICG and Tc99 sulfur colloid. Liver size and sulfur colloid redistribution expressed as a scan score (SS) and redistribution ratio (RR) were assessed from an external scan immediately after the procedure. Improvement in hepatic tests and function was noted between the first and second study. At both the first and second study, the SS (or RR) correlated with the hepatic removal of sulfur colloid (ERSC; r = -0.59; p less than 0.001; HCSC: r = -0.56; p = 0.003) and ICG (ERICG: r = -0.85; p less than 0.001; KICG: r = -0.83; p less than 0.001). ERSC correlated with ERICG (r = 0.76; p less than 0.007) and both correlated with SS and RR consistent with intrahepatic shunting as the mechanism of decreased hepatic clearance and of sulfur colloid redistribution. However, the systemic clearance of sulfur colloid (KSC) did not correlate with redistribution (SS: r = -0.25; NS) at either study period or to ICG clearance (r = 0.23; p = NS) in the first period. The KSC/KICG ratio in both study periods correlated with serum bilirubin (r = 0.83; p less than 0.001 and r = 0.73; p less than 0.001), but was significantly higher in the first period (3.37 +/- 2.37 versus 2.00 +/- 0.75; p less than 0.01). This lack of correlation between intrahepatic shunting and systemic clearance of sulfur colloid is consistent with an increase in the nonhepatic clearance of sulfur colloid in patients with alcoholic liver injury and deep jaundice. A decrease in liver size between the first and second study correlated inversely with change in portal pressure (r = -0.67; p = 0.004) and SS (r = -0.49; p = 0.038) and directly with change in KICG (r = 0.48; p = 0.04). By virtue of these relationships, redistribution of Tc99 sulfur colloid by liver scan may have prognostic significance in patients with alcoholic liver disease.

Topics: Acute Disease; Hepatitis, Alcoholic; Humans; Indocyanine Green; Kinetics; Liver; Liver Cirrhosis, Alcoholic; Liver Diseases, Alcoholic; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Visualization of Ga-67 citrate in the kidneys at 48 hours and 72 hours post injection is usually interpreted as evidence of renal pathology. In reviewing approximately 200 consecutive patients referred for gallium scans, 40 patients who also underwent liver/spleen Tc-99m sulfur colloid (SC) studies within one month of the gallium study were identified. Fourteen of these patients showed advanced hepatocellular dysfunction on the Tc-99m SC liver/spleen images. Of these 14 patients, nine had persistent renal accumulation of gallium at 48 or 72 hours. Five of these nine patients had no evidence of primary renal disease by clinical or postmortem examination and subsequent clinical information indicated that two additional patients probably had no significant renal pathology. Therefore, bilateral symmetrically increased renal uptake of gallium in patients with advanced hepatocellular disease should not necessarily be interpreted as evidence of renal pathology.

Topics: Adult; Aged; Diagnosis, Differential; Gallium Radioisotopes; Humans; Kidney; Kidney Diseases; Liver; Liver Cirrhosis, Alcoholic; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Collateral Circulation; Humans; Hypertension, Portal; Liver; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Umbilical Veins

Tc-99m-sulfur colloid scintigrams were abnormal in four patients with hepatic dysfunction due to chronic alcohol abuse. Minimal uptake of radiocolloid in the liver suggested local reticuloendothelial (RE) cell failure. Imaging with a new hepatobiliary agent, Tc-99m-PIPIDA, revealed rapid hepatic accumulation and excretion of radiotracer with adequate visualization of the organ. Scintigraphic findings in these patients indicated a dissociation of hepatocyte and RE cell functions. Demonstration of adequate hepatocyte function with severe RE failure in alcoholic liver disease using a Tc-99m-labeled hepatobiliary agent has not been previously reported.

Topics: Adult; Aged; Female; Humans; Imino Acids; Liver; Liver Cirrhosis, Alcoholic; Liver Function Tests; Male; Middle Aged; Mononuclear Phagocyte System; Organotechnetium Compounds; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tissue Distribution