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

A hepatic hydrothorax is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. The pleural effusion is derived from ascitic fluid that enters the chest because of the negative pressure within the pleural space via defects in the diaphragm. The peritoneal-to-pleural flow of fluid can be demonstrated by nuclear scanning, even when the ascites is not clinically apparent. The pleural fluid usually has the characteristics of a transudate. However, an occasional patient with hepatic hydrothorax will develop spontaneous bacterial pleuritis manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. Treatment of the hydrothorax is directed at the underlying liver disease but a dyspneic patient can obtain relief from a thoracentesis or paracentesis. When medical therapy fails, liver transplantation is the treatment of choice. Both transjugular intrahepatic portosystemic shunting and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality of these procedures are high because of the fragile nature of the patients.

Topics: Humans; Hydrothorax; Hypertension, Portal; Liver Cirrhosis; Liver Transplantation; Paracentesis; Portasystemic Shunt, Transjugular Intrahepatic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Thoracoscopy

Topics: Breast Neoplasms; Hemangioma; Humans; Liver Abscess; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Organotechnetium Compounds; Phytic Acid; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Amyloidosis; Colloids; Fatty Liver; Glycogen Storage Disease; Granuloma; Hepatitis, Viral, Human; Hodgkin Disease; Humans; Liver Cirrhosis; Liver Diseases; Liver Diseases, Alcoholic; Liver Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Biliary Tract; Colloids; Gallbladder; Gallium Radioisotopes; Humans; Imino Acids; Iodine Radioisotopes; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Rose Bengal; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Ascites; Humans; Hydrothorax; Liver Cirrhosis; Male; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Topics: Abdomen; Humans; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Splenectomy; Splenic Rupture; Splenosis; Technetium Tc 99m Sulfur Colloid

Hydrothorax is an infrequent but well-recognized complication in patients on continuous ambulatory peritoneal dialysis (CAPD) and patients with cirrhotic ascites. It is usually found on the right side; an incidence on both sides is rarely reported. We describe the scintigraphic diagnosis of unusual bilateral peritoneopleural communication in a patient with cirrhotic ascites.

Topics: Ascites; Female; Humans; Liver Cirrhosis; Middle Aged; Peritoneum; Pleura; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

To ascertain the frequency and to describe the clinical and biochemical features of cirrhotic chylothorax.. A descriptive clinical study.. A community teaching hospital.. Since November 1989 to October 1995, 809 patients with pleural effusions were studied by thoracentesis. Pleural effusions with a concentration of triglycerides higher than 110 mg/dL, a pleural fluid to serum triglyceride ratio higher than 1, and a pleural fluid to serum cholesterol ratio lower than 1 were considered chylothorax.. Twenty-four patients had pleural effusions that complied with all three aforementioned biochemical conditions. Five of these 24 patients (20%), were found to have liver cirrhosis as the main cause of chylothorax and in 3 of them, an abdominal source of the effusion could be demonstrated by intraperitoneal injection of a radioisotope (99mTc-sulfur colloid). The cirrhotic chylous effusions had significantly lower (p<0.005) protein (median, 1.7; range, 1.4 to 2.7 g/dL), lactate dehydrogenase (LDH) (median, 96; range, 77 to 138 IU/L), and cholesterol (median, 25; range, 22 to 64 mg/dL) levels than chylous effusions resulting from other causes (protein: median, 4.1; range, 1.7 to 6.8 g/dL; LDH: median, 351; range, 140 to 8,600 IU/L; and cholesterol: median, 87; range, 38 to 160 mg/dL). Cirrhotic chylothorax was always a transudate according to Light's criteria.. Chylothorax is a rare and apparently underappreciated manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. Its uniform biochemical characteristics can facilitate its separation from chylous effusions of different etiology, therefore avoiding potentially harmful diagnostic and therapeutic procedures.

Topics: Adult; Aged; Aged, 80 and over; Ascites; Cholesterol; Chylothorax; Female; Follow-Up Studies; Humans; Incidence; Injections, Intraperitoneal; L-Lactate Dehydrogenase; Liver Cirrhosis; Male; Middle Aged; Paracentesis; Pleural Effusion; Proteins; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Triglycerides

We have postulated that the perfused hepatic mass (PHM) can be estimated by quantitative (volumetric) liver spleen scan (QLSS) using single photon emission computed tomography assessment of sulfur colloid distribution between liver, spleen, and bone marrow. Thus, this parameter should correlate with the amount of functioning tissue in the liver. As a "gold standard" estimate of the nonfibrotic functioning hepatic mass, the weight of the liver at autopsy or transplant was corrected for the amount of scar tissue present. QLSS parameters were correlated with functional hepatic mass in 13 patients with advanced liver disease with liver available at transplant (8 patients) or autopsy (5 patients) who had prior QLSS.. Greater than 1000 mm2 of a liver tissue was assessed histologically in all patients and from more than 2 regions of the liver in 9 of 13 patients. The total fibrosis score (TFS) (range, 0-17.5) was calculated as a semiquantitative estimate of hepatic fibrosis. The ratio of functioning tissue was calculated as (1 - TFS/20) and the amount of functioning tissue as the nonfibrotic weight (NFW): NFW = liver weight x (1--TFS/20). QLSS parameters were measured postprandially and 30 min after injection of 5 mCi of technetium Tc 99m sulfur colloid. Pixel and total counts from the liver, spleen, and bone marrow as well as organ length were measured. Liver/bone marrow index and liver/spleen index were calculated. The perfused hepatic mass (PHM) was defined as the mean of the liver/bone marrow index and liver/spleen index.. All patients had cirrhosis: alcoholic (1 patient), alcoholic with alcoholic hepatitis (1 patient), hepatitis B (3 patients), hepatitis C (6 patients), hepatitis C with hepatocellular carcinoma (1 patient), and primary sclerosing cholangitis (n = 1). The ratio of functioning tissue was 0.54 +/- 0.07; liver weight 1215 +/- 317 g; and NFW = 658 +/- 193 g. The PHM = 55 +/- 14. The PHM calculated from the QLSS correlated strongly with the NFW (functioning tissue) at autopsy/transplant: NFW = 13 PHM - 55; r = 0.9505; p < 0.0001).. In cirrhotic patients (a) we have confirmed that the sulfur colloid distribution by QLSS is determined by the perfused hepatic mass, and (b) the amount of functioning tissue can be precisely estimated by QLSS parameters.

Topics: Autopsy; Biopsy; Female; Fibrosis; Humans; Liver; Liver Cirrhosis; Liver Transplantation; Male; Organ Size; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Tl-201 chloride has been used to image viable tumors in various sites of the body. There has been limited use of Tl-201 below the diaphragm because of normal uptake in the liver, spleen, kidneys, and intestines. The use of sequential Tl-201 and Tc-99m sulfur colloid in the detection and characterization of suspected hepatocellular carcinoma (HCC) was prospectively evaluated.. Four patients with indeterminate liver nodules on radiologic imaging studies were studied with sequential Tl-201 and sulfur colloid liver scans on a triple-headed gamma camera with planar and SPECT acquisition. All patients had subsequent pathologic correlation.. There were three focal nodular HCC lesions and one case of multicentric HCC, size varying between 1.9 cm and greater than 4.0 cm (multicentric HCC). In all lesions, Tl-201 SPECT images showed abnormal increased uptake at sites of HCC, which corresponded to areas of photopenia on sulfur colloid. Computed tomography detected a lesion in two of four patients, whereas US was positive in all patients. However, US was specific for tumor in only one patient and CT was not specific in any patient.. We believe that in patients with suspected HCC, Tl-201 SPECT imaging will have an important role in the detection and characterization of HCC, especially in the cirrhotic patient. Planar Tl-201 hepatic images will usually be normal, except in large lesions, and high-resolution SPECT technique is essential in successful liver tumor imaging.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Child; Gamma Cameras; Humans; Intestines; Kidney; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Prospective Studies; Radiopharmaceuticals; Spleen; Technetium Tc 99m Sulfur Colloid; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography

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

Pleural effusion in the presence of cirrhosis and ascites is well recognized. Peritoneal fluid is thought to enter the pleural cavity either because of overloaded lymphatics or a structural defect between the peritoneal and chest cavities. Pleural effusion rarely occurs in the absence of demonstrable ascites. This report describes the scintigraphic diagnosis of peritoneo-pleural communication in a patient with cryptogenic cirrhosis and pleural effusion without ascites.

Topics: Ascites; Female; Humans; Liver Cirrhosis; Middle Aged; Peritoneal Cavity; Pleural Effusion; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Ascites; Female; Humans; Hydrothorax; Liver Cirrhosis; Middle Aged; Radionuclide Imaging; 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

Hepatoscintigraphic investigations were conducted in 63 patients aged 3 to 15 to study the features of intrahepatic blood flow and degrees of its compensation in children with liver cirrhosis of different stages. 99mTc-colloid was employed as a radiopharmaceutical. Disproportions of scintigraphic liver images showed close correlation with clinico-biochemical and morphological signs of the severity of disease. Subcompensation and decompensation of the organ blood flow and reticuloendothelial system in children with developed and terminal stages of liver cirrhosis are characterized by prolonged blood RP inhibition, a decrease in the total clearance of radioactive colloid, a progressively reduced index of liver clearance, and an increase in a colloid uptake by the spleen.

Topics: Adolescent; Child; Child, Preschool; Humans; Liver; Liver Cirrhosis; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Adult; Humans; Hypertension, Portal; Liver; Liver Cirrhosis; Male; Portal System; Radionuclide Imaging; Schistosomiasis; Technetium Tc 99m Sulfur Colloid

Data from dynamic radiocolloid liver scintigraphy (DLS) have been analysed to calculate three indices of relative arterial to total hepatic perfusion. Ninety subjects have been studied, comprising 21 normals, 62 patients with metastatic liver disease and 7 patients with cirrhosis. Correlation coefficients above 0.81 were found in all patient groups between an index based on rates of liver uptake (the hepatic perfusion index, HPI) and a method based on quantitative liver uptake (the mesenteric fraction, MF). A further method employing the spleen to model arterial inflow (hepatic arterial ratio, HAR) had less agreement with both HPI and MF, with correlation coefficients below 0.76. Posterior images have previously been used to calculate HAR, and greater errors are expected in HAR from the anterior images acquired in this study. Receiver operating characteristic analysis showed that the diagnostic performance of HPI and MF indices in metastatic disease were not significantly different. For anterior image data analysis both HPI and MF were superior to HAR.

Topics: Humans; Liver; Liver Circulation; Liver Cirrhosis; Liver Neoplasms; Radionuclide Imaging; Reference Values; ROC Curve; Technetium Tc 99m Sulfur Colloid

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

Hepatic fibrosis in the pathogenesis of schistosomal glomerulopathy cannot be explained by any positive influence of hepatocellular injury. In order to examine the potential role of impairment of hepatic macrophage function, the t1/2 plasma clearance of 99mTc-sulphur colloid was studied in 30 patients with schistosomal glomerulopathy, ten normal volunteers, ten cases of uncomplicated intestinal schistosomiasis, ten non-schistosomal cirrhotic patients and ten non-schistosomal nephrotic patients. Liver and renal biopsies were obtained from appropriate groups and examined by light microscopy and glomerular immunofluorescence. There was a significant correlation between t1/2 of sulphur colloid clearance and proteinuria, mesangial hypercellularity, and predominance of IgA glomerular deposits. These data indicate that hepatic macrophage dysfunction is an important factor in the pathogenesis of schistosomal glomerulopathy, and that IgA plays a major role in advanced glomerular lesions. The degree of impairment of hepatic macrophage function may influence the pattern and severity of glomerular lesions depending upon the affection of IgA clearance mechanisms.

Topics: Adult; Female; Glomerulonephritis, Membranoproliferative; Humans; Liver Cirrhosis; Macrophages; Male; Middle Aged; Phagocytosis; Proteinuria; Schistosomiasis mansoni; Technetium Tc 99m Sulfur Colloid

Topics: Female; Humans; Liver; Liver Cirrhosis; Middle Aged; Radionuclide Imaging; Situs Inversus; Spleen; Technetium Tc 99m Sulfur Colloid

A new method for the interpretation of data obtained during radionuclide investigation of the reticuloendothelial system (RES) was proposed. It was based on a detailed description of the mechanism of reticuloendothelial extraction of a colloid injected intravenously. A model developed for this purpose included the main stages of radioactive colloid transport. The paper also represented a comparative analysis of the results of clinical examination of the controls and patients with liver cirrhosis. A 4-fold decrease of the blood flow in portal liver cirrhosis was noted as compared with normal mean indices in a 2-fold decrease in the specific blood supply of cells of the RES and in a 2-fold decrease in its volume. An increase in phagocytosis rate in patients with liver cirrhosis needs further verification.

Topics: Algorithms; Female; Humans; Injections, Intravenous; Liver Circulation; Liver Cirrhosis; Male; Mathematics; Middle Aged; Mononuclear Phagocyte System; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Dynamic hepatic scintigraphy was performed in a group of cirrhotic patients to evaluate the optimum imaging and analytical procedures necessary for the measurement of the hepatic perfusion index (HPI). Patients were studied in the posterior (n = 19) and the anterior (n = 14), positions, with either 0.2 or 0.5 ml of 99Tcm sulphur colloid administered as a rapid bolus injection. In each subject, three ROIs (small, medium and large) were drawn over the liver, and time-activity perfusion curves were generated. Analytical techniques were developed to allow flexibility in selecting the arterial and portal venous phases of the liver perfusion curve. The quality of the bolus, expressed as the full width at half-maximum of the left ventricular time--activity curve, was independent of the bolus volumes and patient positioning. The dispersion in the data and the inter-observer variation were less in the anterior view using medium and large ROIs, compared with the anterior small ROI and all the posterior ROI sizes. A time delay between liver and kidney arterial phases, if ignored, produced statistically significant effects on the values of the HPI. We conclude that HPI investigations are best performed in the anterior projection. Data analysis using a large liver ROI is preferred, and flexible data-processing techniques are recommended, particularly in the presence of a liver and kidney arterial time delay.

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

SPECT of the spleen has been performed with 99Tcm-sulphur colloid in 53 patients, and SPECT of the liver has been performed in 57 patients. All patients had histologically proven liver disease and were classified by the degree of severity, Group A-severe, Group B-moderate, Group C-mild. The patients were further classified as cirrhotic and non-cirrhotic. Eight controls were also studied. There is positive though poor correlation between splenic volume and uptake (r2 = 0.55). Splenic volume and uptake are significantly different in Group A patients compared with all other groups (p less than 0.001). They are also significantly different in cirrhotics versus non-cirrhotics and cirrhotics versus controls (p less than 0.001). Splenic SPECT was unhelpful in distinguishing between moderate and mild liver disease. SPECT of the spleen is a time consuming technique but a useful adjunct to liver SPECT in patients with portal hypertension.

Topics: Electronic Data Processing; Female; Humans; Liver; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Models, Structural; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Female; Humans; Hydrothorax; Liver Cirrhosis; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A complex of statistical and dynamic methods for evaluation of the state of parenchyma and organ microcirculation of the liver was used before and after endovascular operations. Liver size, specific count over the right and left lobes of the liver, a ratio of the count over the right lobe to that over the left lobe, spleen size, specific count over the spleen, the liver/spleen ratio, a bone marrow uptake, a contribution of the arterial and venous components to the liver blood supply in a study of the liver blood flow, cardioportal time, a period of semiaccumulation of the drug in the liver and the share of the drug accumulated in the liver in the unit of time were determined. A degree of the importance of each of the quantitative criteria for diagnosis of hepatocirrhosis as well as the nature of regenerative processes after liver retrograde infusion and liver arterial blood flow reduction were shown.

Topics: Humans; Indium; Jaundice; Liver; Liver Cirrhosis; Microcirculation; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Twenty-three patients with hepatic cirrhosis and focal defects on Tc-99m sulfur colloid (SC) scintigrams were restudied with In-111 chloride to determine if indium localization in the focal defect is indicative of a hepatoma. Seven of eight patients with proven hepatomas had positive studies; however, six of 15 patients without hepatomas also had studies interpreted as positive. Thus, In-111 chloride is highly sensitive for the detection of hepatomas, and a negative indium study would militate against this diagnosis. The high false-positive rate found may be due to technical factors rather than a lack of specificity of localization; the experience of others seems to support this impression. At present, In-111 chloride scintigraphy for focal hepatic defects appears to be useful in ruling out hepatoma.

Topics: Carcinoma, Hepatocellular; False Positive Reactions; Humans; Indium; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Sclerotherapy in oesophageal variceal bleeding and portal hypertension is a standardized method. Gastro-oesophageal reflux-scintigraphy was performed in 18 from 90 patients. Augmented reflux of gastric acid and signs of insufficiency could not be shown. Our results indicate that a general treatment for avoiding a relapse of variceal bleeding by reflux is not necessary.

Topics: Esophageal and Gastric Varices; Esophageal Stenosis; Esophagogastric Junction; Esophagus; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Radionuclide Imaging; Sclerosing Solutions; Technetium Tc 99m Sulfur Colloid

Dynamic liver scanning using 99mTc sulphur colloid has been used in assessing 41 patients with cirrhosis and the data compared with 33 control subjects. The mesenteric fraction (MF) was significantly reduced in cirrhotics (0.30 +/- 0.17) compared with controls (0.58 +/- 0.09), P less than 0.001. The liver: spleen ratio (L:S) was also significantly different (1.6 +/- 0.95 compared with 4.9 +/- 1.4), P less than 0.001. Those patients who had undergone a recent variceal bleed had values less than patients who had not bled. Dynamic scintigraphy may be of value in monitoring the progress of disease and response to treatment.

Topics: Adult; Aged; Female; Humans; Liver Circulation; Liver Cirrhosis; Male; Mesenteric Arteries; Middle Aged; Portal System; Radionuclide Imaging; Splenic Artery; Technetium Tc 99m Sulfur Colloid; Time Factors

We compared light pen (LPEN) and Region of Interest (ROI) computer methods in determining spleen-to-liver (S/L) ratios both in anterior and posterior images in various liver diseases. The S/L ratio was independent of age or type of colloid used (equal particle size provided). Results with corresponding LPEN and ROI programs did not differ significantly from each other. The sensitivity and specificity were tested and the anterior view yielded somewhat better results than the posterior view but the best results were obtained when both projections were used. The sensitivity for all liver diseases was 60% and the corresponding specificity 93%. In hepatocellular diseases the sensitivity was 80-100%, but the S/L ration had only 37% sensitivity for hepatic metastases. Hepatomegaly in the anterior view was found in 67% of fatty liver cases, in 25% of cirrhosis cases, in 20% of hepatitis and in 25% of metastatic livers. Splenomegaly was noted in 39-54% of patients with hepatocellular diseases but only in 4-10% of metastatic diseases.

Topics: Adult; Aged; Fatty Liver; Hepatitis; Humans; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spleen; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds

A recurrent unilateral pleural effusion developed without obvious cause in two patients with cirrhosis of the liver. By the demonstration of the rapid passage of a radiolabelled colloid from abdomen to thorax, these effusions were proved to be secondary to clinically undetectable peritoneal effusions. A diaphragmatic tear, which had occurred during a previous splenectomy and which was apparent only at autopsy, was the cause of peritoneopleural communication in one patient. Previous surgery could also have been responsible for the pleural effusion in the other patient.

Topics: Child; Diaphragm; Female; Humans; Liver Cirrhosis; Liver Cirrhosis, Biliary; Middle Aged; Pleural Effusion; Postoperative Complications; Radionuclide Imaging; Recurrence; Splenectomy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The source of massive pleural effusion was not apparent in a 58-year-old man who had cirrhosis but no demonstrable ascites. Intraperitoneal injection of technetium Tc 99m sulfur colloid established the presence of peritoneopleural communication. This diagnostic technique can be helpful in evaluating patients with cirrhosis of the liver and pleural effusion with or without ascites.

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

Topics: Adult; Aged; Carcinoma, Hepatocellular; Colloids; Cysts; Female; Hemangioma; Humans; Liver Abscess; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Gallium Radioisotopes; Humans; Liver; Liver Cirrhosis; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Colloids; Female; Humans; Hypertension, Portal; Liver Circulation; Liver Cirrhosis; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Umbilical Veins

An application of the ROC statistical method is described on a sample of 161 patients who underwent hepatic gammagraphy and biopsies obtained by laparoscopy, and of whom 90 were found to have hepatic cirrhosis according to pathological anatomy. Five decision thresholds have been established in the elaboration of the gammagraphic diagnosis of cirrhosis. The true positive fraction (TPF) and false positive fraction (FPF) of these five thresholds are shown on an ordinate axis and an ROC curve is obtained. By means of a simplified cost-benefit analysis the optimal point of operation for this type of diagnosis is determined on this curve, according to which the diagnosis of cirrhosis should be considered positive when alterations in the size of the liver and distribution of the isotope in the liver are found simultaneously with splenomegaly.

Topics: Humans; Liver Cirrhosis; Radionuclide Imaging; Statistics as Topic; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Plasma lysozyme levels have been reported to reflect the functional status of the reticuloendothelial system (RES). We measured plasma lysozyme levels in 22 patients with acute hepatitis and 21 patients with cirrhosis and a mesocaval shunt. In 17 of these patients RES function was assessed by measuring the disappearance rate (t/2) of radio-labelled sulphur colloid. In acute hepatitis plasma lysozyme levels and colloid t/2 were significantly lower than in health controls and cirrhotics. In the acute hepatitis patients, the plasma lysozyme levels rose significantly two weeks after admission as the hepatitis improved. The colloid t/2 of the 17 patients with liver disease was significantly correlated with the plasma lysozyme level (r = +0.66, p = 0.005). These results suggest that in human liver disease, in comparison with animal experiments, plasma lysozyme is dependent on RES functional status in the sense that a more active RES will result in a lower lysozyme level.

Topics: Acute Disease; Adult; Aged; Female; Hepatitis; Humans; Liver Cirrhosis; Male; Middle Aged; Mononuclear Phagocyte System; Muramidase; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Absence of the right hepatic lobe following blunt abdominal trauma without surgical resection is reported. The usual site of the right hepatic lobe is demonstrated to be occupied by bowel by hepatobiliary imaging.

Topics: Abdominal Injuries; Atrophy; Cholecystectomy; Cholecystitis; Humans; Imino Acids; Intestines; Liver; Liver Cirrhosis; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors; Wounds, Nonpenetrating

Topics: Adult; Aged; Child; Colloids; Female; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography