EARLY RADIONUCLIDE DETECTION OF INTRAPULMONARY SHUNTS IN CHILDREN WITH LIVER-DISEASE

In order to detect and quantify imtrapulmonary shunts in children with liver disease, a radionuclide method was developed and evaluated in s uch a population. Methods: We studied 135 children in whom the severit y of liver disease, in most cases, justified consideration of liver tr ansplantation. Patients were separated into two groups according to th eir 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 th e lungs (L) and brain (B) was counted. A shunt index (SI) was calculat ed as SI = 100.B/L. We compared this index with blood gases and clinic al follow-up. Results: In the normoxic group, SI was 0.43 +/- 0.30 (me an +/- 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 hypoxi c children with SI > 1 later developed severe hypoxemia. Conclusions: Scintigraphy with intravenous human albumin macroaggregates is more ac curate than measuring arterial blood gases to detect IFS in children w ith cirrhosis.