Brunot B, Petras S, Germain P, Vinee P, Constantinesco A
Laboratoire de Biophysique et Médecine Nucléaire, CHRU Hautepierre, Strasbourg, France.
J Nucl Med. 1994 Aug;35(8):1321-7.
Hepatobiliary scintigraphy with technetium-99m-mebrofenin including a first-pass study of 60 two-sec images and a functional phase of 40 one-min images was performed in 26 patients (42.5 +/- 12.5 yr) in the early postoperative period (9.1 +/- 4.3 days) after liver grafting. Needle biopsy was carried out within a mean of 0.5 +/- 2.2 days of the scintigraphy study. Considering only rejection and cholestasis, biopsy results were used to classify the patients in three groups: control group I (11 patients) with minimal lesions, group II (9 patients) with moderate histologic modifications, and group III (6 patients) with severe dysfunction showing important structural changes. First-pass time-activity curves were used to calculate arterial (alpha-A) and portal (alpha-P) angles as well as a portal perfusion index. Functional time-activity curves were used to define two blood retention indices (BRI1 and BRI2) and two liver uptake indices (LUI1 and LUI2). Excretion was not quantified.
Simple linear regression analysis showed a significant correlation between portal perfusion index and BRI1 (p < 0.05, r = -0.43) and BRI2 (p = 0.01, r = -0.53). The validity of the histologic classification was assessed by the existence of significantly different (p < 0.05) mean values for alpha-P, portal perfusion index and LUI1 in the three groups. All other indices could distinguish significantly between groups I and II. Furthermore, arterial angle alpha-A allowed differentiation of group II from group III but not group I from group II; on the contrary, LUI2 and BRI1 distinguished group I from group II but not group II from group III.
This study demonstrated a close correlation between early biopsy results and perfusion indices in patients with a liver graft as well as uptake parameters determined by hepatobiliary scintigraphy.
对26例（年龄42.5±12.5岁）肝移植术后早期（9.1±4.3天）的患者进行了锝-99m-美罗芬宁肝胆闪烁显像，包括60帧两秒图像的首过研究和40帧一分钟图像的功能期研究。在闪烁显像研究平均0.5±2.2天内进行了针吸活检。仅考虑排斥反应和胆汁淤积，活检结果用于将患者分为三组：对照组I（11例），病变轻微；II组（9例），有中度组织学改变；III组（6例），有严重功能障碍，显示重要的结构变化。利用首过时间-活性曲线计算动脉角（α-A）和门静脉角（α-P）以及门静脉灌注指数。功能时间-活性曲线用于定义两个血液潴留指数（BRI1和BRI2）和两个肝脏摄取指数（LUI1和LUI2）。未对排泄进行定量分析。
简单线性回归分析显示门静脉灌注指数与BRI1（p<0.05，r=-0.43）和BRI2（p=0.01，r=-0.53）之间存在显著相关性。通过三组中α-P、门静脉灌注指数和LUI1的平均值存在显著差异（p<0.05）来评估组织学分类的有效性。所有其他指数在I组和II组之间有显著差异。此外，动脉角α-A可区分II组和III组，但不能区分I组和II组；相反，LUI2和BRI1可区分I组和II组，但不能区分II组和III组。
本研究表明肝移植患者的早期活检结果与灌注指数以及肝胆闪烁显像测定的摄取参数之间存在密切相关性。
