title: The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation.
abstract: BACKGROUND
  The macro-aggregated albumin lung perfusion scan (99mTc-MAA) is a diagnostic method for hepatopulmonary syndrome (HPS).
  
  
  OBJECTIVE
  To determine the sensitivity of 99mTc-MAA in diagnosing HPS, to establish the utility of 99mTc-MAA in determining the influence of HPS on hypoxemia in patients with concomitant pulmonary disease and to determine the correlation between 99mTc-MAA values and other respiratory parameters.
  
  
  METHODS
  Data from 115 cirrhotic patients who were eligible for liver transplantation (LT) were prospectively analyzed. A transthoracic contrast echocardiography and 99mTc-MAA were performed in 85 patients, and 74 patients were diagnosed with HPS.
  
  
  RESULTS
  The overall sensitivity of 99mTc-MAA for the diagnosis of HPS was 18.9% (14/74) in all of the HPS cases and 66.7% (4/6) in the severe to very severe cases. In HPS patients who did not have lung disease, the degree of brain uptake of 99mTc-MAA was correlated with the alveolar-arterial oxygen gradient (A-a PO2) (r = 0.32, p < 0.05) and estimated oxygen shunt (r = 0.41, p < 0.05) and inversely correlated with partial pressure of arterial oxygen (PaO2) while breathing 100% O2 (r = -0.43, p < 0.05). The 99mTc-MAA was positive in 20.6% (7/36) of the patients with HPS and lung disease. The brain uptake of 99mTc-MAA was not associated with mortality and normalized in all cases six months after LT.
  
  
  CONCLUSIONS
  The 99mTc-MAA is a low sensitivity test for the diagnosis of HPS that can be useful in patients who have concomitant lung disease and in severe to very severe cases of HPS. It was not related to mortality, and brain uptake normalized after LT.
authors.affiliation: Aparato Digestivo, HAR de Ecija, España .
authors.forename: Israel
authors.initials: I
authors.lastname: Grilo
authors.affiliation: Digestivo, Hospital Virgen del Rocio.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Pascasio
authors.affiliation: Medicina Nuclear, Hospital Virgen del Rocio.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Tirado
authors.affiliation: Cardiología, Hospital Virgen del Rocio.
authors.forename: Francisco-Jesús
authors.initials: FJ
authors.lastname: López-Pardo
authors.affiliation: Neumología, Hospital Virgen del Rocio.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ortega-Ruiz
authors.affiliation: UGC Enfermedades Digestivas, Martín, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Sousa
authors.affiliation: Cardiología, Hospital Virgen del Rocio.
authors.forename: María José
authors.initials: MJ
authors.lastname: Rodríguez-Puras
authors.affiliation: UGC Enfermedades Digestivas, Hospital Virgen del Rocio.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Ferrer
authors.affiliation: Unidad de Trasplante Hepático, Hospital Universitario Virgen del Rocío, ESPAÑA.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Gómez-Bravo
authors.affiliation: Medicina Interna, Hospital Virgen de Valme.
authors.forename: Antonio
authors.initials: A
authors.lastname: Grilo Reina
mesh_terms: D000328:Adult; D000418:Albumins; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000418:Albumins; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C075321:macro aggregates of albumin