Korean J Med.  2000 Feb;58(2):152-160.

The study of the shunt index of thallium-201 liver scintigraphy and liver biopsy in the patients with chronic liver disease

• Yoo YJ
• Jung JW
• Choi CS
• Jeon DW
• Lee OY
• Choi HS
• Yoon BC
• Hahm JS
• Lee MH
• Choi YY
• Hong EK
• Park MH
• Lee JW

Abstract

BACKGROUND: The disturbances of portal circulation in chronic liver disease may cause hepatic failure, hepatic encephalopathy and variceal bleeding. The measure of porto-systemic shunt plays a significant role in the management and prognosis of the patients. So we have evaluated the relationship between the shunt index of thallium-201 liver scan and the histological grade and stage of chronic liver disease.
METHODS
The thallium-201 scintigraphy per rectum was evaluated in 159 patients with chronic liver disease, which were proven with percutaneous liver biopsy. We used the heart to liver activity ratio at 20 minute as shunt index, representing portal-systemic shunt. The two pathologists scored independently hepatitis activity (lobular and porto-periportal activity) and stage (fibrosis).
RESULTS
A significant difference was noted between the shunt index and the scores of fibrosis (p< 0.001) although this correlation was statistically weak (r=0.26, p=0.008). In cumulative logistic regression test, the shunt index had a effect on the fibrosis (p< 0.001) but not on the lobular and porto-periportal activity. Fibrosis was predicted as less than 2 if shunt index was less than 0.24, 3 if more than 0.24 but less than 0.46, 4 if more than 0.46.
CONCLUSION
The shunt index of thallium-201 liver scintigraphy correlated only with fibrosis not with lobular and porto-periportal activity. As the fibrosis progresses in chronic liver disease, portal hypertension becomes more severe and the shunt index increases. Thallium-201 liver scan may be useful for evaluation of hepatic fibrosis instead of invasive liver biopsy in predicting the histological stage (fibrosis) of advanced chronic liver disease.

Keyword

Thallium-201 liver scintigraphy; Chronic liver disease; Histological Grade and Stage; Shunt Index

MeSH Terms

Biopsy*
Esophageal and Gastric Varices
Fibrosis
Heart
Hepatic Encephalopathy
Hepatitis
Humans
Hypertension, Portal
Liver Diseases*
Liver Failure
Liver*
Logistic Models
Prognosis
Radionuclide Imaging*
Rectum