Radiocolloid estimation of hepatic portal perfusion

Journal Article

The authors have developed a scintigraphic technique, which can be performed in conjunction with visceral angiography, for calculating the fraction of superior mesenteric venous (SMV) blood that bypasses liver sinusoids through extrahepatic and intrahepatic collaterals. Following sequential injections of 99mTc sulfur colloid (SC) and 99mTc human serum albumin (HSA) into the superior mesenteric artery, time course of isotope appearance in the heart is monitored with a gamma camera-computer system. First pass time-activity curves for both substances are constructed and shunt index (SI) for SC determined as integral of SC counts divided by integral of HSA counts. SI was calculated in 4 dogs before and after end-to-side portacaval shunt. Total shunting of portal flow was considered to represent an SI = 1.00 and all other values were adjusted to this baseline (corrected SI). Seven preoperative determinations averaged 0.19 ± 0.05 SD (0.12 to 0.26) and the mean of 4 postshunt measurements was 0.99 ± 0.13 (0.85 to 1.16; P < 0.001). Subsequently, the authors have performed SI determinations during routine preoperative angiography in 24 cirrhotic patients with portal hypertension. Fourteen studies (58%) have been interpretable by the authors' preset criteria. Corrected SI ranged from 0.36 to 1.12 with a mean of 0.81 ± 0.22 DS in this patient population. Regression analysis of corrected SI versus angiogram grade (venous phase of superior mesenteric angiogram) resulted in an r = 0.62 (P < 0.05). Five individuals (36%) had corrected SI ≥ 0.98, suggesting total diversion of SMV flow through extrahepatic and intrahepatic shunts. The authors conclude that, whereas visceral angiography provides only a qualitative index of volumetric hepatic portal perfusion, SI gives a quantitative measure of the fraction of SMV blood perfusing liver sinusoids. This technique may be of assistance in selecting the appropriate portasystemic shunting procedure for patients who have bled from esophageal varices.

Full Text

Cited Authors

  • Rikkers, LF; Miller, F; Nelson, JA; Christian, P; Coleman, RE

Published Date

  • 1980

Published In

Volume / Issue

  • 29 / 4

Start / End Page

  • 293 - 301

International Standard Serial Number (ISSN)

  • 0022-4804

Digital Object Identifier (DOI)

  • 10.1016/0022-4804(80)90061-X