A low right-to-left hepatic lobe ratio. Is streamlining of ethanol to the right lobe of the liver the cause?

The anterior view of a liver-spleen scintigram performed with Tc-99m sulfur colloid was used to calculate the right-to-left (R/L) hepatic lobe ratio in three patients (acute hepatitis, normal, alcoholic cirrhosis). Emission computed tomography (ECT) was also performed, and the images correlated with the data obtained from the planar images. A low R/L hepatic lobe ratio correctly identified the patient with alcoholic cirrhosis. Streamlining of ethanol to the right (R) lobe of the liver has been suggested as the principal reason why the R/L hepatic ratio is decreased in alcoholic cirrhosis. The evaluation of the ECT images, however, suggest that the count density in each lobe of the liver is similar in the patient with alcoholic cirrhosis. The latter and known information regarding the absorption of ethanol from the gastrointestinal tract are not in agreement with the alcohol streamlining theory.