Dynamic hepatic scintigraphy in the screening of psoriatic patients for methotrexate-induced hepatotoxicity.
We report the use of dynamic hepatic scintigraphy in the assessment of the hepatic status of psoriatic patients before and during methotrexate therapy. Eighty-seven paired dynamic scans and percutaneous liver biopsies were performed in 63 patients. The liver biopsies were graded according to Warin et al. with fibrosis of grade 2 or worse being a strong indication for withdrawal of methotrexate. The sensitivity of dynamic hepatic scintigraphy in detecting fibrosis of grade 2 or worse was 83.3% and the specificity was 81.5%. The predictive value of a normal scan for fibrosis of grade 0-1 was high (98.5%) although the predictive value of an abnormal scan for fibrosis of grade 2 or worse was low (25%). Dynamic hepatic scintigraphy may therefore offer a means to reduce the number of liver biopsies necessary in patients receiving methotrexate for psoriasis.
McHenry
P M
PM
Department of Dermatology, Royal Victoria Hospital, Belfast, U.K.
Bingham
E A
EA
Callender
M E
ME
Delvin
P B
PB
O'Hara
M D
MD
Ferguson
W R
WR
Laird
J D
JD
Burrows
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011565:Psoriasis / Q000188:drug therapy*; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity
D008727:Methotrexate