Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake
| Autor: | Jiaywei Tsauo, He Zhao, Huaiyuan Ma, Gong-Shun Tang, Xiao Li, Ningna Weng, Xiaowu Zhang |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Radionuclide imaging Hypertension Pulmonary Perfusion Imaging Technetium-99m-labeled macroaggregated albumin lung perfusion scan Intrapulmonary vascular dilations medicine Humans Prospective Studies Vascular Diseases Prospective cohort study Hepatopulmonary syndrome Portal hypertension Lung Technetium Tc 99m Aggregated Albumin Brain uptake Lung Perfusion Scan business.industry Liver Diseases Gastroenterology Brain General Medicine Middle Aged medicine.disease Oxygen Sensitivity and specificity Diagnostic tests Prospective Study Macroaggregated albumin Female Blood Gas Analysis Radiopharmaceuticals Nuclear medicine business Whole body Technetium-99m Dilatation Pathologic Hepatopulmonary Syndrome |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 2219-2840 |
| Popis: | BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension. This syndrome occurs most often in cirrhotic patients (4%–32%) and has been shown to be detrimental to functional status, quality of life, and survival. The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e., diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects, preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient, respectively. AIM To compare brain and whole-body uptake of technetium for diagnosing HPS. METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included. Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs, respectively. RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhanced echocardiography. The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71 ± 0.18 mg/dL vs 0.83 ± 0.23 mg/dL; P = 0.041), alveolar-arterial oxygen gradient (23.2 ± 13.3 mmHg vs 16.4 ± 14.1 mmHg; P = 0.043), and arterial partial pressure of oxygen (81.0 ± 12.1 mmHg vs 90.1 ± 12.8 mmHg; P = 0.004). Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0% ± 6.1% vs 40.1% ± 8.1%; P = 0.001). The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54; P = 0.025). The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7% and 42.5%, respectively, based on Youden’s index. The sensitivity, specificity, and accuracy of brain uptake > 5.7% and whole-body uptake > 42.5% for detecting IPVD were 23%, 89%, and 59% and 100%, 52%, and 74%, respectively. CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS. |
| Databáze: | OpenAIRE |
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