Hoefs J C, Wang F, Kanel G
University of California Irvine Medical Center, Department of Medicine, Orange 92668, USA.
Am J Gastroenterol. 1997 Nov;92(11):2054-8.
We have postulated that the perfused hepatic mass (PHM) can be estimated by quantitative (volumetric) liver spleen scan (QLSS) using single photon emission computed tomography assessment of sulfur colloid distribution between liver, spleen, and bone marrow. Thus, this parameter should correlate with the amount of functioning tissue in the liver. As a "gold standard" estimate of the nonfibrotic functioning hepatic mass, the weight of the liver at autopsy or transplant was corrected for the amount of scar tissue present. QLSS parameters were correlated with functional hepatic mass in 13 patients with advanced liver disease with liver available at transplant (8 patients) or autopsy (5 patients) who had prior QLSS.
Greater than 1000 mm2 of a liver tissue was assessed histologically in all patients and from more than 2 regions of the liver in 9 of 13 patients. The total fibrosis score (TFS) (range, 0-17.5) was calculated as a semiquantitative estimate of hepatic fibrosis. The ratio of functioning tissue was calculated as (1 - TFS/20) and the amount of functioning tissue as the nonfibrotic weight (NFW): NFW = liver weight x (1--TFS/20). QLSS parameters were measured postprandially and 30 min after injection of 5 mCi of technetium Tc 99m sulfur colloid. Pixel and total counts from the liver, spleen, and bone marrow as well as organ length were measured. Liver/bone marrow index and liver/spleen index were calculated. The perfused hepatic mass (PHM) was defined as the mean of the liver/bone marrow index and liver/spleen index.
All patients had cirrhosis: alcoholic (1 patient), alcoholic with alcoholic hepatitis (1 patient), hepatitis B (3 patients), hepatitis C (6 patients), hepatitis C with hepatocellular carcinoma (1 patient), and primary sclerosing cholangitis (n = 1). The ratio of functioning tissue was 0.54 +/- 0.07; liver weight 1215 +/- 317 g; and NFW = 658 +/- 193 g. The PHM = 55 +/- 14. The PHM calculated from the QLSS correlated strongly with the NFW (functioning tissue) at autopsy/transplant: NFW = 13 PHM - 55; r = 0.9505; p < 0.0001).
In cirrhotic patients (a) we have confirmed that the sulfur colloid distribution by QLSS is determined by the perfused hepatic mass, and (b) the amount of functioning tissue can be precisely estimated by QLSS parameters.
我们推测，通过单光子发射计算机断层扫描评估硫胶体在肝脏、脾脏和骨髓之间的分布，利用定量（容积）肝脏脾脏扫描（QLSS）可以估算灌注肝质量（PHM）。因此，该参数应与肝脏中功能组织的数量相关。作为非纤维化功能肝质量的“金标准”估计值，尸检或移植时肝脏的重量已根据存在的瘢痕组织量进行了校正。对13例晚期肝病患者的QLSS参数与功能肝质量进行了相关性分析，这些患者在移植（8例）或尸检（5例）时有肝脏可供研究，且之前已进行过QLSS检查。
对所有患者的超过1000mm²肝脏组织进行组织学评估，13例患者中的9例从肝脏的2个以上区域取材。计算总纤维化评分（TFS）（范围为0 - 17.5），作为肝纤维化的半定量估计值。功能组织的比例计算为（1 - TFS/20），功能组织的量计算为非纤维化重量（NFW）：NFW = 肝脏重量×（1 - TFS/20）。餐后及注射5mCi锝Tc 99m硫胶体30分钟后测量QLSS参数。测量肝脏、脾脏和骨髓的像素和总计数以及器官长度。计算肝脏/骨髓指数和肝脏/脾脏指数。灌注肝质量（PHM）定义为肝脏/骨髓指数和肝脏/脾脏指数的平均值。
所有患者均患有肝硬化：酒精性肝硬化（1例）、酒精性肝硬化合并酒精性肝炎（1例）、乙型肝炎（3例）、丙型肝炎（6例）、丙型肝炎合并肝细胞癌（1例）和原发性硬化性胆管炎（n = 1）。功能组织的比例为0.54±0.07；肝脏重量为1215±317g；NFW = 658±193g。PHM = 55±14。根据QLSS计算的PHM与尸检/移植时的NFW（功能组织）密切相关：NFW = 13PHM - 55；r = 0.9505；p < 0.0001）。
在肝硬化患者中，（a）我们已证实QLSS的硫胶体分布由灌注肝质量决定，（b）功能组织的量可通过QLSS参数精确估算。
