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

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

The perfused Kupffer cell mass determines sulfur colloid distribution by liver spleen scan (LSS) and is proportional to the perfused hepatocyte mass. This accounts for the correlation of sulfur colloid distribution with tests of hepatic function and raises the question of whether the LSS can be used as a quantitative test of hepatic function. The recent ability to precisely measure sulfur colloid distribution by single-photon-emission computerized tomography (SPECT) prompted us to evaluate the clinical value in 329 consecutive patients with adequate LSS and clinical information, of which 27 apparent normals and 220 patients with chronic liver disease (CLD) were included in this study. The liver-bone marrow index (LBI) indicated the distribution of counts between the liver and bone marrow. The liver-spleen index (LSI) indicated the distribution between liver and spleen adjusted for spleen size. The LBI and LSI correlated with each other (r = 0.753; P < 0.001). The arithmetic mean of LBI and LSI was defined as the severity score. Detailed clinical evaluation was available in these patients and included 109 who had liver biopsy. A severity score in 27 normals was 102 +/- 5 (mean +/- SD) with all values > 85. The severity score correlated with hepatic fibrosis (r = -0.694; P < 0.001) in 109 patients with benign liver disease who had recent biopsies and with the Child-Pugh classification (r = 0.78; P < 0.001) in 220 patients with CLD.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Biopsy; Chronic Disease; Humans; Kupffer Cells; Liver; Liver Diseases; Liver Diseases, Alcoholic; Liver Function Tests; Severity of Illness Index; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

In evaluating alcoholic liver disease in a patient with pulmonary tuberculosis, a liver-spleen scan was performed that showed an unusual uptake of sulfur colloid in the lungs. There was diffuse uptake in the left lung and portions of the right lower lung with absent uptake in the right upper lobe and portions of the right lower lung corresponding to areas of pulmonary consolidation. A perfusion lung scan confirmed absent pulmonary arterial perfusion in these areas and a gallium scan demonstrated active infection there.

Topics: Female; Humans; Liver; Liver Diseases, Alcoholic; Lung; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tuberculosis, Pulmonary

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