CLINICAL USEFULNESS OF EVALUATION OF PORTAL CIRCULATION BY PER RECTALPORTAL SCINTIGRAPHY WITH TC-99M PERTECHNETATE

Objective: Portal circulation, in particular the contribution of the i nferior mesenteric vein, can be evaluated in a relatively noninvasive way by per rectal portal scintigraphy (J Nucl Med 1988;29:460-5). The clinical usefulness of the method was evaluated. Methods: A solution c ontaining technitium-99m pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the l iver and heart were recorded sequentially. By analyses of the curves, the per rectal portal shunt index (SI) was calculated. Results: The SI was higher for disorders that were more severe, increasing in the ord er of chronic persistent hepatitis, chronic aggressive hepatitis, and cirrhosis, and the SI was higher in cirrhotic patients than in patient s with chronic hepatitis or in healthy subjects. The SI was significan tly higher when a complication (varices, ascites, or encephalopathy) w as present. Correlation between the SI and classic indicators for func tional reserve was significant. The SI was significantly related to su rvival according to results of regression analysis by Cox's proportion al hazards model. On the basis of the SI when patients were first exam ined, the patients with cirrhosis were divided into three groups of ro ughly equal size: group A, SI under 30%; group B, SI between 30 and 70 %; and group C, SI over 70%. The survival rate was lower in group B th an in A, lower in group C than in A, and lower in group C than in B. C onclusions: This method is clinically useful, especially in establishi ng the prognosis.