99mTc-HEPIDA hepatic clearance as a diagnostic tool: usefulness of plasma and hepatic clearance for assessment of hepatic parenchyma performance.
Plasma clearance of (99m)Tc-HEPIDA (Cl(Pl)) has been used for two decades for assessment of liver function in patients with diseases of this organ. A specific determination of (99m)Tc-HEPIDA liver clearance (Cl(Hp)) has been developed that provides more direct possibility to evaluate performance of liver parenchyma. Both tests have been studied in healthy volunteers of varying age (48 individuals) and in 83 patients with varying degree of liver damage. The liver damage has been evaluated on the basis of 5 biochemical tests (AspAT, ALAT, GGTP, bilirubine serum concentration, proteinogram) and a score system used for total impairment, which was calculated for each patient. Normal range of Cl(Pl) and Cl(Hp) was determined from a study on healthy individuals (volunteers). The results seem independent of age, but show sex differences. The following values (mean +/- SD) of Cl(Hp) were found in males and females of: (181 +/- 31) ml//min/1.73 m(2) and (158 +/- 22) ml/min/1.73m(2), and of Cl(Pl) were (224 +/- 33) ml/min/1.73 m(2) and (202 +/- 25) ml/min/1.73 m(2) respectively. Accepted lower boundaries of both quantities (mean -2SD) are 115 ml/min/1.73 m(2) and 150 ml/min/1.73 m(2) correspondingly. Negative correlation of individual values of both clearances in all patients with individual score of liver damage were highly significant and correlation coefficients obtained were higher for Cl(Hp) (r = -0.63) than those for Cl(Pl) (r= -0.56). Factorial analysis was performed with the intention of seeing which of the studied factors had the highest factor loading for parenchyma performance that was assumed as the common factor responsible for correlations. The highest value was obtained for hepatic clearance (Cl(Hp)) of (99m)Tc-HEPIDA. In conclusion this quantity seems highly promising as a clinically useful test for assessment of liver performance, both in screening for liver damage and for monitoring of organ conditions during therapy and follow-up of patients.
Nuclear Medicine Department of the Medical University, Łódź, Poland.
Izabela
I
Frieske
Marian J
MJ
Surma
Małgorzata
M
Bieńkiewicz
Jolanta
J
Białkowska-Warzecha
Julian
J
Liniecki
Jan
J
Kuydowicz
Jacek
J
Kuśmierek
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D002908:Chronic Disease; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003947:Diagnostic Techniques, Radioisotope; D005260:Female; D006801:Humans; D007098:Imino Acids / Q000097:blood* / Q000493:pharmacokinetics; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism; D008107:Liver Diseases / Q000097:blood* / Q000000981:diagnostic imaging*; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D015609:Organotechnetium Compounds / Q000097:blood* / Q000493:pharmacokinetics; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000097:blood / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000637:Transaminases / Q000097:blood; D005723:gamma-Glutamyltransferase / Q000097:blood
D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C483504:technetium Tc 99m 2,6-dimethylacetanilideiminodiacetic acid; D005723:gamma-Glutamyltransferase; D000637:Transaminases; D000410:Alanine Transaminase; C022636:serine-glyoxylate aminotransferase; D001663:Bilirubin