Determination of hepatic circulatory changes in portal hypertension using 133Xe injection-method

The purpose of the present study was to investigate the change in hepatic circulation in patients with liver diseases including idiopathic portal hypertension (IPH). We determined the ratio (A/P ratio) of hepatic blood flow supplied from the hepatic artery (A-HBF) to hepatic blood flow supplied from the portal vein (P-HBF), total hepatic blood flow (HBF), and splenic blood flow following the administration of 133Xe in 13 cases with IPH, 28 cases with chronic hepatitis, 9 cases with pre-cirrhosis, 66 cases with liver cirrhosis, and 15 healthy subjects. The results are shown as follows: 1) In IPH cases, A/P ratio increased significantly compared to healthy subjects, while A-HBF increased slightly. However, A-HBF markedly increased in two cases with IPH operated for splenectomy and esophageal transection in childhood. 2) The reduction in HBF in the patients with IPH was probably due to the decrease in P-HBF, which was observed particularly in cases having extrahepatic portasystemic shunt. 3) Splenic blood flow in patients with IPH increased significantly compared to those in patients with chronic hepatitis and with liver cirrhosis. 4) A/P ratio increased corresponding with the process to liver cirrhosis. This increase of A/P ratio was observed in patients from the pre-cirrhotic stage, which was mainly due to the decrease in P-HBF. 5) Compensatory increase in A-HBF was observed distinctly in patient with liver cirrhosis. A/P ratio was high in cirrhotic cases who had marked extrahepatic portasystemic shunt. 6) A/P ratio increased markedly in cases with decompensated cirrhosis, particularly in the cases terminating in hepatic failure. (author)