Differentiation of liver transplantation complications by quantitative analysis of dynamic hepatobiliary scintigraphy.
OBJECTIVE
We retrospectively investigated the value of dynamic Tc-diisopropyl-iminodiacetic acid hepatobiliary scintigraphy (HBS) in discriminating postsurgical complications following liver transplantation (LT).


METHODS
Dynamic HBS was performed for suspected post-LT complications in 201 cases. Hepatic uptake and excretion was visually graded. The portal perfusion index (PPI) and kinetic parameters were quantitatively analyzed.


RESULTS
HBS findings were normal in all 119 (59%) cases without complications. Complications were confirmed in 82 cases: 24 had graft rejection, 48 had biliary obstruction, and 10 had hepatitis. Visual grades of uptake and excretion were abnormal for all three types of complications and showed no discriminative value. The PPI level was significantly higher for grafts with rejection (0.83 ± 0.07) compared with no complication (0.57 ± 0.08), biliary obstruction (0.69 ± 0.06), and hepatitis (0.65 ± 0.07; all P<0.0001). Receiver operating characteristic curve analysis confirmed PPI to be highly accurate for discerning rejection from no rejection (area under the curve, 0.97; sensitivity, 95.8%; specificity, 91.7%) or biliary obstruction (area under the curve, 0.93; sensitivity, 95.8%; specificity, 79.2%).


CONCLUSIONS
PPI measured from dynamic HBS offers a highly accurate method for identifying post-LT rejection and distinguishing it from biliary obstruction or hepatitis.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ji Young
JY
Lee
Wei
W
Hu
Kyung-Han
KH
Lee
Choon Hyuck
CH
Kwon
Eun Jeong
EJ
Lee
Joon Young
JY
Choi
Byung-Tae
BT
Kim
D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D002614:Chelating Agents; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology; D006505:Hepatitis / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007098:Imino Acids; D016031:Liver Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D002614:Chelating Agents; D007098:Imino Acids; D015609:Organotechnetium Compounds; C008109:iminodiacetic acid