title: Clinical usefulness of scintigraphy with 99mTc-galactosyl-human serum albumin for prognosis of cirrhosis of the liver.
abstract: Scintigraphy with 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) is useful for evaluating hepatic functional reserve. We assessed the clinical usefulness of this technique, including its value in establishing a prognosis, in patients with cirrhosis of the liver.
  
  
  METHODS
  Scintigraphy with 99mTc-GSA was performed in 10 healthy subjects, 42 patients with chronic hepatitis and 158 patients with cirrhosis. Computer acquisition of gamma camera data were started just before the injection of 99mTc-GSA. Time-activity curves for the heart and liver were generated from regions of interest (ROIs) for the heart and the entire liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver-plus-heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI at 15 min by that of the heart ROI at 3 min.
  
  
  RESULTS
  The median receptor index was lower in patients with cirrhosis than in patients with chronic hepatitis or in healthy subjects, and the median index of blood clearance was higher. The receptor index was significantly lower when a complication (varices, ascites) was present. The index of blood clearance was significantly higher when a complication (varices and ascites) was present. Correlation of the two indices with classic indicators for functional reserve was significant. On the basis of the receptor index, the patients with cirrhosis were divided into two groups of roughly equal size: group A, receptor index over 0.85, and group B, receptor index 0.85 or less. On the basis of the index of blood clearance, the patients with cirrhosis were divided into two groups of roughly equal size: group A, index of blood clearance < 0.70, and group B, index of blood clearance > or = 0.70. The cumulative survival rates were lower in group B than in group A.
  
  
  CONCLUSIONS
  Scintigraphy with 99mTc-GSA is clinically useful, especially in establishing the prognosis of patients with cirrhosis of the liver.
authors.affiliation: Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sasaki
authors.forename: S
authors.initials: S
authors.lastname: Shiomi
authors.forename: Y
authors.initials: Y
authors.lastname: Iwata
authors.forename: S
authors.initials: S
authors.lastname: Nishiguchi
authors.forename: T
authors.initials: T
authors.lastname: Kuroki
authors.forename: J
authors.initials: J
authors.lastname: Kawabe
authors.forename: H
authors.initials: H
authors.lastname: Ochi
mesh_terms: D001201:Ascites / Q000000981:diagnostic imaging; D003198:Computer Simulation; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging; D005583:Fourier Analysis; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008111:Liver Function Tests; D019047:Phantoms, Imaging; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015996:Survival Rate; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics; D016284:Technetium Tc 99m Pentetate / Q000493:pharmacokinetics; D013696:Temperature; D013997:Time Factors
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate