Die sequentielle Hepatospleno-Szintigraphie zur quantitativen Beurteilung der Leberdurchblutung^*

Abstract

The arterial and portal components of total liver blood flow were determined quantitatively in 31 patients by means of a new, non-invasive method. Sequential hepato-splenic scintigraphy has been employed, using a scintillation camera linked to a computer system. In normals, the proportion of portal flow was 71%, whereas in patients with portal hypertension it averaged 21%. Our experience indicates that the procedure can be of considerable value in the pre-operative diagnosis and postoperative follow-up of portal hypertension.

Transit-time studies with Levovist in patients with and without hepatic cirrhosis: A promising new diagnostic tool

“…There are several intra-and extrahepatic haemodynamic changes in patients with cirrhosis that contribute to the observed early arrival time: arterialization of the liver substantially increases the amount of microbubbles that reach the liver during the early arterial phase rather than during the later portal venous phase of liver first pass. This was also found by several investigators using nuclear medicine techniques which provide quantitative information about the degree of arterialization (the ªhepatic perfusion indexº) in patients with cirrhosis [23,24,25,26], but isotope studies are not widely used clinically in the differential diagnosis of diffuse liver disease because of the considerable overlap between patients with cirrhosis and controls. Intrahepatic shunts reduce Data are given as mean values standard deviation the transit time through the liver since a significant amount of blood bypasses the liver sinusoids.…”

Zum Stellenwert der Sperr- und Shunt-operationen bei der Therapie der rezidi- vierenden Ösophagus- und/oder Magen· varizenblutung des Leberzirrhotikers

“…Für den distalen splenorenalen Shunt fordern wir den Nachweis einer Pfortader restperfusion von 30% [23. 26], Sie entspricht dem hepatischen Perfusionsindex (PI), der nichtinvasiv sequenzszintigraphisch [26,30] oder neuerdings im Duplexverfahren unter Einsatz des Dopplers ermittelt werden kann [31,32]. Als einziges invasives Verfahren fordern wir eine Leberbiopsie, die möglichst laparo skopisch.…”

Transjugular Intrahepatic Portosystemic Shunt and Hepatic Encephalopathy

“…For example, Transjugular Intrahepatic Portosystemic Shunt and Hepatic Encephalopathy patients with a very slow or stagnant portal vein flow or those with retrograde flow direc tion in the portal vein have a high or even 100% extrahepatic shunting. Intrahepatic shunting may be determined by scintigraphy [6] or measured more invasively by clearance technique [7], In addition, the degree of shunting may be estimated by the plasma con centrations of gut-derived agents with a high hepatic extraction ratio. Their bioavailability is low under normal conditions but high in the presence of portosystemic shunting.…”