Shijo H, Hisano S, Sasaki H, Yuh K, Kusuhara H, Sakaguchi S, Okumura M, Sakata H
Department of Internal Medicine, School of Medicine, Fukuoka University, Japan.
Clin Nucl Med. 1989 Mar;14(3):179-82. doi: 10.1097/00003072-198903000-00008.
Two cases of liver cirrhosis associated with marked hypoxemia are presented. Chest radiographs and cardiopulmonary function showed no abnormalities, except for the low diffusion capacity of carbon monoxide and slight elevation of the shunt ratio (20 and 6.2%, respectively), as estimated under conditions of 100% oxygen inhalation. Pulmonary perfusion imaging with Tc-99m macroaggregated albumin (MAA) revealed a significant radioisotope uptake in the lungs, brain, spleen, and both kidneys. Shunt ratios, estimated by the quantitative radionuclide method, were 60 and 68%, respectively. Dynamic pulmonary perfusion imaging revealed a gradual reduction in uptake in all areas of both lungs. The discrepancy of the shunt ratio between the two methods results from an abnormal dilatation of alveolar capillaries. The gradual reduction of radioactivity in areas of the lungs is caused by the passage of MAA particles through widened pulmonary capillaries.
本文报告了两例伴有明显低氧血症的肝硬化病例。胸部X光片和心肺功能检查均未发现异常，仅在吸入100%氧气的条件下，一氧化碳弥散能力降低，分流率略有升高（分别为20%和6.2%）。用锝-99m大颗粒聚合白蛋白（MAA）进行肺灌注显像显示，肺、脑、脾和双肾均有明显的放射性同位素摄取。通过定量放射性核素法估算的分流率分别为60%和68%。动态肺灌注显像显示双肺所有区域的摄取逐渐减少。两种方法测得的分流率存在差异是由于肺泡毛细血管异常扩张所致。肺部区域放射性的逐渐减少是由于MAA颗粒通过增宽的肺毛细血管所致。
