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Portal Circulation by Technetium-99m Pertechnetate Per-Rectal Portal Scintigraphy

Third Department of Internal Medicine, Department of Public Health, and Department of Radiology, Osaka City University Medical School, Osaka, Japan

Correspondence: For reprints contact: Susumu Shiomi, MD, Third Department of Internal Medicine, Osaka City University Medical School, Asahi-machi 1-5-7, Abeno-ku, Osaka 545, Japan.

ABSTRACT

Portal circulation in patients with chronic liver diseases was evaluated by [^99mTc]pertechnetate per-rectal scintigraphy. Technetium-99m pertechnetate (10 mCi) was instilled into the upper rectum, and serial scintigrams were taken. Radioactivity curves for the liver and heart were then recorded sequentially. Through analysis of these curves, the per-rectal portal shunt index (SI) was calculated for six healthy subjects and 228 patients, 59 with chronic hepatitis, seven with idiopathic portal hypertension, six with primary biliary cirrhosis, and 156 with cirrhosis. In the healthy subjects, the SI was 1.9–5.2% (mean 4.1%). In hepatitis, the mean SI was 7.1%, and in cirrhosis, 52.9%. The SI was higher in cirrhotic patients with esophageal varices than in those without (p < 0.001), and in cirrhotic patients with encephalopathy than in those without (p < 0.01). For some patients with portal hypertension, portal collateral circulation could be depicted, and images of changes in the portal collateral circulation after vascular anastomosis were seen.

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