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Early Radionuclide Detection of Intrapulmonary Shunts in Children with Liver Disease

Departments of Nuclear Medicine and Pediatric Hepatology, Hôpital de Bicêtre, Bicêtre
Department of Physiology, Hôpital Antoine Béclère, Clamart, France

Correspondence: For correspondence or reprints contact: Gilles Grimon, MD, Service de Medecine Nucleaire, Hopital de Bicetre, Bicetre, 94275 France.

ABSTRACT

In order to detect and quantify intrapulmonary shunts in children with liver disease, a radionuclide method was developed and evaluated in such a population. Methods: We studied 135 children in whom the severity of liver disease, in most cases, justified consideration of liver transplantation. Patients were separated into two groups according to their resting PaO₂ values under room air: 109 children were normoxic and 26 were hypoxic. A radionuclide scan was performed immediately after intravenous injection of human albumin macroaggregates. Activity of the lungs (L) and brain (B) was counted. A shunt index (SI) was calculated as SI = 100 · B/L. We compared this index with blood gases and clinical follow-up. Results: In the normoxic group, SI was 0.43 ± 0.30 (mean ± s.d.); none of the 102 children with SI < 1 developed hypoxemia during their follow-up. Two of the six children with SI > 1 developed subsequent hypoxemia. In the hypoxic group, the nine children with SI < 1 did not aggravate their hypoxemia during follow-up. The 17 hypoxic children with SI > 1 later developed severe hypoxemia. Conclusions: Scintigraphy with intravenous human albumin macroaggregates is more accurate than measuring arterial blood gases to detect IPS in children with cirrhosis.

Key Words: pediatrics • technetium-99m-albumin macroaggregates • intrapulmonary shunt • hypoxemia • hepatic cirrhosis • portal hypertension • liver transplantation

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