Per-rectal portal scintigraphy is complementary to ultrasonography and endoscopy in the assessment of portal hypertension in children with chronic cholestasis.
We evaluated the clinical usefulness of 99mTc-pertechnetate per-rectal portal scintigraphy (PPS) in the assessment of portal circulation in children with chronic cholestasis.


METHODS
PPS percentage shunt index (%SI) (the amount of radionuclide that shunts the liver and reaches the systemic blood after injection in the rectum) was measured in 22 children (mean age, 7.2 +/- 4.9 y) and compared with established clinical, laboratory, and endoscopic and imaging parameters of portal hypertension (PH). Fourteen children had surgically treated biliary atresia, and 8 had chronic intrahepatic cholestasis. Six clinically well children served as control subjects.


RESULTS
The %SI was 14.3 +/- 3.1 and 34.7 +/- 18.8 in controls and in patients, respectively (P < 0.01). A cutoff of 19% correctly allocated 100% of controls and 86% of patients. Mean %SI values were significantly higher in patients with biliary atresia, a high risk of pretransplantation death, esophageal varices (EV) at endoscopy, and an abnormal value for the ratio of lesser omentum thickness to abdominal aorta diameter (LO/Ao) at ultrasonography. Correlations between %SI values and several ultrasonographic continuous variables were statistically significant only for LO/Ao ratios (r = 0.51; P = 0.005) and spleen longitudinal diameters (r = 0.53; P = 0.01). The presence of EV could correctly be predicted only when values of %SI were greater than 30% (100% specificity; 56% sensitivity). Endoscopic and PPS findings agreed for a diagnosis of PH with EV in 3 of 7 patients with normal or borderline ultrasonographic LO/Ao ratios. PPS patterns and %SI values became normal in 3 children who underwent liver transplantation.


CONCLUSIONS
In children with chronic cholestasis, PPS may be an advantageous, minimally invasive tool complementary to ultrasonography and endoscopy for better assessment and follow-up of PH before and after liver transplantation.
Department of Pediatrics, Medical School of the University of Naples Federico II, Naples, Italy. vajro@unina.it
Pietro
P
Vajro
Luigi
L
Celentano
Francesco
F
Manguso
Gianfranco
G
Vallone
Selvaggia
S
Lenta
Claudia
C
Mandato
Nicolina
N
Di Cosmo
Grazia
G
Capuano
Annamaria
A
Staiano
Agesilao
A
D'Arienzo
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002908:Chronic Disease; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D007223:Infant; D008297:Male; D011168:Portal System / Q000000981:diagnostic imaging* / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012007:Rectum / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m; D014463:Ultrasonography / Q000379:methods
D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m