Sasaki N, Shiomi S, Iwata Y, Nishiguchi S, Kuroki T, Kawabe J, Ochi H
Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan.
J Nucl Med. 1999 Oct;40(10):1652-6.
Scintigraphy with 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) is useful for evaluating hepatic functional reserve. We assessed the clinical usefulness of this technique, including its value in establishing a prognosis, in patients with cirrhosis of the liver.
Scintigraphy with 99mTc-GSA was performed in 10 healthy subjects, 42 patients with chronic hepatitis and 158 patients with cirrhosis. Computer acquisition of gamma camera data were started just before the injection of 99mTc-GSA. Time-activity curves for the heart and liver were generated from regions of interest (ROIs) for the heart and the entire liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver-plus-heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI at 15 min by that of the heart ROI at 3 min.
The median receptor index was lower in patients with cirrhosis than in patients with chronic hepatitis or in healthy subjects, and the median index of blood clearance was higher. The receptor index was significantly lower when a complication (varices, ascites) was present. The index of blood clearance was significantly higher when a complication (varices and ascites) was present. Correlation of the two indices with classic indicators for functional reserve was significant. On the basis of the receptor index, the patients with cirrhosis were divided into two groups of roughly equal size: group A, receptor index over 0.85, and group B, receptor index 0.85 or less. On the basis of the index of blood clearance, the patients with cirrhosis were divided into two groups of roughly equal size: group A, index of blood clearance < 0.70, and group B, index of blood clearance > or = 0.70. The cumulative survival rates were lower in group B than in group A.
Scintigraphy with 99mTc-GSA is clinically useful, especially in establishing the prognosis of patients with cirrhosis of the liver.
用99m锝-二乙烯三胺五乙酸-半乳糖基人血清白蛋白（99mTc-GSA）进行闪烁扫描对评估肝功能储备很有用。我们评估了这项技术在肝硬化患者中的临床实用性，包括其在判断预后方面的价值。
对10名健康受试者、42例慢性肝炎患者和158例肝硬化患者进行了99mTc-GSA闪烁扫描。在注射99mTc-GSA之前就开始用计算机采集γ相机数据。从心脏和整个肝脏的感兴趣区（ROI）生成心脏和肝脏的时间-活性曲线。通过将注射后15分钟时肝脏ROI的放射性除以肝脏加心脏ROI的放射性来计算受体指数。通过将15分钟时心脏ROI的放射性除以3分钟时心脏ROI的放射性来计算血液清除指数。
肝硬化患者的中位受体指数低于慢性肝炎患者或健康受试者，中位血液清除指数更高。出现并发症（静脉曲张、腹水）时受体指数显著更低。出现并发症（静脉曲张和腹水）时血液清除指数显著更高。这两个指数与功能储备的经典指标之间存在显著相关性。根据受体指数，将肝硬化患者大致分为两组，每组人数大致相等：A组，受体指数大于0.85；B组，受体指数小于或等于0.85。根据血液清除指数，将肝硬化患者大致分为两组人数大致相等：A组，血液清除指数<0.70；B组，血液清除指数≥0.70。B组的累积生存率低于A组。
99mTc-GSA闪烁扫描在临床上很有用，尤其是在判断肝硬化患者的预后方面。
