title: Assessment of risk of complications in cirrhosis using portal thallium scans.
abstract: OBJECTIVE
  To investigate the usefulness of a novel thallium scan shunt index for assessing portosystemic shunt-related cirrhotic complications.
  
  
  METHODS
  We enrolled 209 chronic hepatitis B-related cirrhosis patients. After rectal thallium instillation, radioactive isotope activity in the heart and liver was measured. The ratio of radiation uptake between the heart and the liver was calculated (the shunt index). This value indicates the degree of portosystemic circulation shunting. Blood tests, serum biochemistry tests, abdominal ultrasonography, gastroscopy and examination of clinical features such as the occurrence of varices, bleeding and hepatic encephalopathy were performed. Multivariate analysis was used to identify independent risk factors for complications. We compared the cumulative incidence rates of complications during the follow-up period.
  
  
  RESULTS
  The thallium scan shunt index was significantly higher in the decompensated liver cirrhosis group than in the compensated liver cirrhosis group (0.91 ± 0.39 vs 0.39 ± 0.32, P < 0.001). It was also higher in the varices group, the hepatic encephalopathy group, and the variceal bleeding group than in the control group (P < 0.001). Multivariate analysis showed that the index was an independent risk factor for predicting decompensated liver cirrhosis. When the cut-off value was 0.75, the shunt index had a sensitivity of 82.6%, a specificity of 84%, a positive predictive value of 61.5%, and a negative predictive value of 94.4% in diagnosing decompensated cirrhosis. When the shunt index was greater than 0.75, there was a significant increase in the number of decompensated events.
  
  
  CONCLUSIONS
  The thallium shunt index is a good predictor of cirrhosis-related complications.
authors.affiliation: Hye-Jin Tae, Dae-Won Jun, Min-Ho Lee, Department of Internal Medicine, Hanyang University School of Medicine, Seoul 133-792, South Korea.
authors.forename: Hye-Jin
authors.initials: HJ
authors.lastname: Tae
authors.affiliation: Hye-Jin Tae, Dae-Won Jun, Min-Ho Lee, Department of Internal Medicine, Hanyang University School of Medicine, Seoul 133-792, South Korea.
authors.forename: Dae-Won
authors.initials: DW
authors.lastname: Jun
authors.affiliation: Hye-Jin Tae, Dae-Won Jun, Min-Ho Lee, Department of Internal Medicine, Hanyang University School of Medicine, Seoul 133-792, South Korea.
authors.forename: Yun-Young
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Hye-Jin Tae, Dae-Won Jun, Min-Ho Lee, Department of Internal Medicine, Hanyang University School of Medicine, Seoul 133-792, South Korea.
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Kwak
authors.affiliation: Hye-Jin Tae, Dae-Won Jun, Min-Ho Lee, Department of Internal Medicine, Hanyang University School of Medicine, Seoul 133-792, South Korea.
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Lee
mesh_terms: D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000821:virology; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000821:virology; D006321:Heart / Q000000981:diagnostic imaging*; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000821:virology; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000821:virology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000821:virology; D016015:Logistic Models; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012307:Risk Factors; D013794:Thallium Radioisotopes; D013997:Time Factors
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes
keywords: Decompensation; Liver cirrhosis; Portosystemic shunt