Biopsy and quantitative hepatobiliary scintigraphy in the evaluation of liver transplantation.
METHODS
Hepatobiliary scintigraphy with technetium-99m-mebrofenin including a first-pass study of 60 two-sec images and a functional phase of 40 one-min images was performed in 26 patients (42.5 +/- 12.5 yr) in the early postoperative period (9.1 +/- 4.3 days) after liver grafting. Needle biopsy was carried out within a mean of 0.5 +/- 2.2 days of the scintigraphy study. Considering only rejection and cholestasis, biopsy results were used to classify the patients in three groups: control group I (11 patients) with minimal lesions, group II (9 patients) with moderate histologic modifications, and group III (6 patients) with severe dysfunction showing important structural changes. First-pass time-activity curves were used to calculate arterial (alpha-A) and portal (alpha-P) angles as well as a portal perfusion index. Functional time-activity curves were used to define two blood retention indices (BRI1 and BRI2) and two liver uptake indices (LUI1 and LUI2). Excretion was not quantified.


RESULTS
Simple linear regression analysis showed a significant correlation between portal perfusion index and BRI1 (p < 0.05, r = -0.43) and BRI2 (p = 0.01, r = -0.53). The validity of the histologic classification was assessed by the existence of significantly different (p < 0.05) mean values for alpha-P, portal perfusion index and LUI1 in the three groups. All other indices could distinguish significantly between groups I and II. Furthermore, arterial angle alpha-A allowed differentiation of group II from group III but not group I from group II; on the contrary, LUI2 and BRI1 distinguished group I from group II but not group II from group III.


CONCLUSIONS
This study demonstrated a close correlation between early biopsy results and perfusion indices in patients with a liver graft as well as uptake parameters determined by hepatobiliary scintigraphy.
Brunot
B
B
Laboratoire de Biophysique et Médecine Nucléaire, CHRU Hautepierre, Strasbourg, France.
Petras
S
S
Germain
P
P
Vinee
P
P
Constantinesco
A
A
D000328:Adult; D000814:Aniline Compounds; D001707:Biopsy, Needle; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005998:Glycine; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007098:Imino Acids; D016014:Linear Models; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D016031:Liver Transplantation / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D015609:Organotechnetium Compounds; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D013997:Time Factors
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D005998:Glycine