QUANTITATIVE-EVALUATION OF THE HEPATIC FUNCTIONAL RESERVE USING TC-99M DTPA-GALACTOSYL HUMAN SERUM-ALBUMIN BEFORE AND AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

Transjugular intrahepatic portosystemic shunt (TIPS), a new therapeuti c method, has been performed widely for the treatment of portal hypert ension. TIPS produces a decrease in the portal blood flow to the hepat ic parenchyma, which is considered to cause a reduction in hepatic fun ctional reserve, To evaluate the chang es in hepatic functional reserv e after TIPS, we performed technetium-99m DTPA-galactosyl human serum algumin (Tc-99m-GSA) hepatic scintigraphy before and after TIPS in eig ht male patients, ranging in age from 54 to 72 years (mean 62.2 years) . Two quantitative indices - blood clearance index (uptake ratio of th e heart at 15 min to that at 3 min, HH15) and hepatic accumulation ind ex (uptake ratio of the liver to the liver plus heart at 15 min, LHL15 ) - were calculated from the time-activity curves of the heart and liv er, Early and late uptake constant indices (early and late KU) were al so calculated from the time-activity curves of the heart and liver by means of Patlak plot. The values of HH15, LHL15 and late KU deteriorat ed after TIPS in all patients. Early KU (1-3 min) decreased by more th an 55% in two patients who showed a poor prognosis and corresponded we ll with the status of the portosystemic shunt. It is concluded that Tc -99m-GSA hepatic scintigraphy is a useful means of evaluating the degr ee to which hepatic function is compromised following TIPS. The post-T IPS alterations in HH15, LHL15 and late KU (5-10 min) reflect the chan ges in hepatic functional reserve, and early KU is a useful index for evaluating the degree of portosystemic shunt.