期刊论文详细信息
Journal of Nuclear Medicine
Per-Rectal Portal Scintigraphy Is Complementary to Ultrasonography and Endoscopy in the Assessment of Portal Hypertension in Children with Chronic Cholestasis
Luigi Celentano1  Selvaggia Lenta1  Nicolina Di Cosmo1  Agesilao D’Arienzo1  Francesco Manguso1  Gianfranco Vallone1  Pietro Vajro1  Annamaria Staiano1  Claudia Mandato1  Grazia Capuano1 
关键词: biliary atresia;    esophageal varices;    portal hypertension;    per-rectal portal scintigraphy;   
DOI  :  
学科分类:医学(综合)
来源: Society of Nuclear Medicine
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【 摘 要 】

We evaluated the clinical usefulness of 99mTc-pertechnetate per-rectal portal scintigraphy (PPS) in the assessment of portal circulation in children with chronic cholestasis. Methods: PPS percentage shunt index (%SI) (the amount of radionuclide that shunts the liver and reaches the systemic blood after injection in the rectum) was measured in 22 children (mean age, 7.2 ± 4.9 y) and compared with established clinical, laboratory, and endoscopic and imaging parameters of portal hypertension (PH). Fourteen children had surgically treated biliary atresia, and 8 had chronic intrahepatic cholestasis. Six clinically well children served as control subjects. Results: The %SI was 14.3 ± 3.1 and 34.7 ± 18.8 in controls and in patients, respectively (P < 0.01). A cutoff of 19% correctly allocated 100% of controls and 86% of patients. Mean %SI values were significantly higher in patients with biliary atresia, a high risk of pretransplantation death, esophageal varices (EV) at endoscopy, and an abnormal value for the ratio of lesser omentum thickness to abdominal aorta diameter (LO/Ao) at ultrasonography. Correlations between %SI values and several ultrasonographic continuous variables were statistically significant only for LO/Ao ratios (r = 0.51; P = 0.005) and spleen longitudinal diameters (r = 0.53; P = 0.01). The presence of EV could correctly be predicted only when values of %SI were greater than 30% (100% specificity; 56% sensitivity). Endoscopic and PPS findings agreed for a diagnosis of PH with EV in 3 of 7 patients with normal or borderline ultrasonographic LO/Ao ratios. PPS patterns and %SI values became normal in 3 children who underwent liver transplantation. Conclusion: In children with chronic cholestasis, PPS may be an advantageous, minimally invasive tool complementary to ultrasonography and endoscopy for better assessment and follow-up of PH before and after liver transplantation.

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