Use of scintigraphy with (99m)technetium galactosyl human serum albumin for staging of primary biliary cirrhosis and assessment of prognosis

Background: Conventional models for prediction of survival in patients with primary biliary cirrhosis (PBC) are based on the results of blood tests an d on the clinical condition, which may be affected by treatment. We evaluat ed the usefulness of hepatic receptor imaging with [(99m)technetium]-diethy lenetriaminepentaacetic acid galactosyl human serum albumin (GSA) for the s taging and prognosis of PBC without the need for reference to laboratory te st results. Methods: The subjects were 45 patients with PBC, 10 healthy subjects, 62 pa tients with chronic hepatitis and 144 patients with cirrhosis. Computer acq uisition of gamma-camera data was started just before the injection of 185 MBq [Tc-99m]-GSA and was stopped 20 min later. Time-activity curves were ge nerated from regions of interest (ROI) for the heart and liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver-plus-heart ROI 15 min after the injection, An index of blood clearance was calculated by dividing the radioactivity of the heart ROI 15 min after the injection by that of the heart ROI 3 min after the injection. Results: The median receptor index was higher in patients with PBC than in those with cirrhosis. Among patients with PBC, the receptor index was lower in those with stage IV disease than in those in stages I, II or III. The i ndex of blood clearance was lower in patients with PBC than in those with c irrhosis. Among patients with PBC, the index of blood clearance was higher in those with stage IV disease than in those in stages I, II or III. The re ceptor index was correlated significantly both to the risk score of the May o model and to the prognostic index of the Japanese model. The index of blo od clearance was also correlated significantly to this score and prognostic index. Conclusions: Hepatic receptor imaging with [Tc-99m]-GSA is useful for the e valuation of hepatic functional reserve, staging of PBC and assessment of p rognosis, (C) 1999 Blackwell Science Asia Pty Ltd.