Dragoteanu Mircea, Balea Ioan-Adrian, Piglesan Cecilia-Diana
Mircea Dragoteanu, Ioan-Adrian Balea, Cecilia-Diana Piglesan, Department of Nuclear Medicine, Regional Institute for Gastroenterology and Hepatology, Prof. Dr. Octavian Fodor, 400162 Cluj-Napoca, Romania.
World J Hepatol. 2014 Apr 27;6(4):251-62. doi: 10.4254/wjh.v6.i4.251.
To investigate the hepatic hemodynamics in the Budd-Chiari syndrome (BCS) using per-rectal portal scintigraphy (PRPS) and liver angioscintigraphy (LAS).
Fourteen consecutive patients with BCS were evaluated by PRPS between 2003 and 2012. Ten of them underwent LAS and liver scan (LS) with Tc-99m colloid. Eleven patients had clinical manifestations and three were asymptomatic, incidentally diagnosed at PRPS. The control group included 15 healthy subjects. We used new parameters at PRPS, the liver transit time of portal inflow and the blood circulation time between the right heart and liver. PRPS offered information on the hepatic areas missing venous outflow or portal inflow, length and extent of the lesions, open portosystemic shunts (PSS), involvement of the caudate lobe (CL) as an intrahepatic shunt and flow reversal in the splenic vein. LAS was useful in the differential diagnosis between the BCS and portal obstructions, highlighting the hepatic artery buffer response and reversed portal flow. LS offered complementary data, especially on the CL.
We described three hemodynamic categories of the BCS with several subtypes and stages, based on the finding that perfusion changes depend on the initial number and succession in time of the hepatic veins (HVs) obstructions. Obstruction of one hepatic vein (HV) did not cause opening of PSS. The BCS debuted by common obstruction of two HVs had different hemodynamic aspects in acute and chronic stages after subsequent obstruction of the third HV. In chronic stages, obstruction of two HVs resulted in opening of PSS. The BCS, determined by thrombosis of the terminal part of the inferior vena cava, presented in the acute stage with open PSS with low speed flow. At least several weeks are required in the obstructions of two or three HVs for the spontaneous opening of dynamically efficient PSS. The CL seems to have only a transient important role of intrahepatic shunt in several types of the BCS.
Dynamic nuclear medicine investigations assess the extent and length of hepatic venous obstructions, open collaterals, areas without portal inflow, hemodynamic function of the CL and reverse venous flow.
采用经直肠门静脉闪烁造影（PRPS）和肝脏血管闪烁造影（LAS）研究布加综合征（BCS）的肝脏血流动力学。
2003年至2012年间，对14例连续性BCS患者进行PRPS评估。其中10例患者接受了LAS及用锝-99m胶体进行肝脏扫描（LS）。11例患者有临床表现，3例无症状，因PRPS偶然诊断。对照组包括15名健康受试者。我们在PRPS中采用了新参数，即门静脉血流的肝脏通过时间以及右心与肝脏之间的血液循环时间。PRPS提供了有关肝脏区域静脉流出或门静脉流入缺失、病变长度和范围、开放的门体分流（PSS）、作为肝内分流的尾状叶（CL）受累情况以及脾静脉血流逆转的信息。LAS有助于BCS与门静脉梗阻的鉴别诊断，突出肝动脉缓冲反应和门静脉血流逆转。LS提供了补充数据，特别是关于CL的。
基于灌注变化取决于肝静脉（HV）梗阻的初始数量和时间顺序这一发现，我们描述了BCS的三种血流动力学类型，伴有多种亚型和阶段。一条肝静脉（HV）梗阻不会导致PSS开放。由两条HV共同梗阻引发的BCS在第三条HV随后梗阻后的急性期和慢性期具有不同的血流动力学表现形式。在慢性期，两条HV梗阻导致PSS开放。由下腔静脉末端血栓形成所致的BCS在急性期表现为开放的PSS且血流速度低。两条或三条HV梗阻后至少需要数周时间才能使动态有效的PSS自发开放。在几种类型的BCS中，CL似乎仅在肝内分流中起短暂的重要作用。
动态核医学检查可评估肝静脉梗阻的范围和长度以及开放的侧支、无门静脉流入的区域、CL的血流动力学功能和静脉血流逆转情况。
