Investigation of hepatic perfusion in prehepatic portal hypertension by dynamic hepatobiliary scintigraphy. A clinical and experimental study

Dynamic hepatobiliary scintigraphy (DHbSc) was used in the indirect investigation of hepatic perfusion in patients with prehepatic portal hypertension (PPH). Parameters of the 99mTc-HIDA transport rate were evaluated from time vs. activity curves in the liver region of interest. The study was based on the assumption that changes in the extraction of the radiopharmaceutical (RAP) by the liver, and thus the shape of the liver curve at DHbSc correlate in PPH patients with intact liver parenchyma with changes of blood flow in the liver. This assumption had been tested experimentally in dogs before and after artificial induction of PPH, and in a group of 23 PPH patients with either spontaneously developed collaterals or established portosystemic (PS) shunt. In experiments, the curves of PPD-induced dogs showed a delayed RAP transport. A similar liver curve pattern was observed in PPH patients with spontaneously developed collaterals. In patients with PS shunt the pattern of the liver curves was close to normal. It can be concluded from the results that patients with PS shunt have a better liver perfusion that patients with spontaneously developed collaterals. Dynamic hepatobiliary scintigraphy seems to be a suitable indirect indicator of the state of liver perfusion in PPH patients, and thus also in the assessment of the development of the disease with impact on therapeutic tactics. (author)