@article {Vajro1705, author = {Pietro Vajro and Luigi Celentano and Francesco Manguso and Gianfranco Vallone and Selvaggia Lenta and Claudia Mandato and Nicolina Di Cosmo and Grazia Capuano and Annamaria Staiano and Agesilao D{\textquoteright}Arienzo}, title = {Per-Rectal Portal Scintigraphy Is Complementary to Ultrasonography and Endoscopy in the Assessment of Portal Hypertension in Children with Chronic Cholestasis}, volume = {45}, number = {10}, pages = {1705--1711}, year = {2004}, publisher = {Society of Nuclear Medicine}, abstract = {We evaluated the clinical usefulness of 99mTc-pertechnetate per-rectal portal scintigraphy (PPS) in the assessment of portal circulation in children with chronic cholestasis. Methods: PPS percentage shunt index (\%SI) (the amount of radionuclide that shunts the liver and reaches the systemic blood after injection in the rectum) was measured in 22 children (mean age, 7.2 {\textpm} 4.9 y) and compared with established clinical, laboratory, and endoscopic and imaging parameters of portal hypertension (PH). Fourteen children had surgically treated biliary atresia, and 8 had chronic intrahepatic cholestasis. Six clinically well children served as control subjects. Results: The \%SI was 14.3 {\textpm} 3.1 and 34.7 {\textpm} 18.8 in controls and in patients, respectively (P \< 0.01). A cutoff of 19\% correctly allocated 100\% of controls and 86\% of patients. Mean \%SI values were significantly higher in patients with biliary atresia, a high risk of pretransplantation death, esophageal varices (EV) at endoscopy, and an abnormal value for the ratio of lesser omentum thickness to abdominal aorta diameter (LO/Ao) at ultrasonography. Correlations between \%SI values and several ultrasonographic continuous variables were statistically significant only for LO/Ao ratios (r = 0.51; P = 0.005) and spleen longitudinal diameters (r = 0.53; P = 0.01). The presence of EV could correctly be predicted only when values of \%SI were greater than 30\% (100\% specificity; 56\% sensitivity). Endoscopic and PPS findings agreed for a diagnosis of PH with EV in 3 of 7 patients with normal or borderline ultrasonographic LO/Ao ratios. PPS patterns and \%SI values became normal in 3 children who underwent liver transplantation. Conclusion: In children with chronic cholestasis, PPS may be an advantageous, minimally invasive tool complementary to ultrasonography and endoscopy for better assessment and follow-up of PH before and after liver transplantation.}, issn = {0161-5505}, URL = {https://jnm.snmjournals.org/content/45/10/1705}, eprint = {https://jnm.snmjournals.org/content/45/10/1705.full.pdf}, journal = {Journal of Nuclear Medicine} }