Assessment of risk of complications in cirrhosis using portal thallium scans

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 1; pp. 228 - 234
• Main Authors: Tae, Hye-Jin, Jun, Dae-Won, Choi, Yun-Young, Kwak, Min-Jung, Lee, Min-Ho
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 07.01.2014
• Subjects: Brief; cirrhosis; Decompensation; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - physiopathology; Esophageal and Gastric Varices - virology; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - physiopathology; Gastrointestinal Hemorrhage - virology; Heart - diagnostic imaging; Hepatic Encephalopathy - diagnostic imaging; Hepatic Encephalopathy - physiopathology; Hepatic Encephalopathy - virology; Hepatitis B, Chronic - complications; Humans; Hypertension, Portal - diagnostic imaging; Hypertension, Portal - physiopathology; Hypertension, Portal - virology; Incidence; Kaplan-Meier Estimate; Liver; Liver - diagnostic imaging; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - physiopathology; Liver Cirrhosis - virology; Logistic Models; Multivariate Analysis; Portosystemic; Predictive Value of Tests; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Risk Assessment; Risk Factors; shunt; Thallium Radioisotopes; Time Factors; Liver cirrhosis; Portosystemic shunt; Decompensation
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i1.228

AIM:To investigate the usefulness of a novel thallium scan shunt index for assessing portosystemic shuntrelated cirrhotic complications.METHODS:We enrolled 209 chronic hepatitis B-related cirrhosis patients.After rectal thallium instillation,radioactive isotope activity in the heart and liver was measured.The ratio of radiation uptake between the heart and the liver was calculated(the shunt index).This value indicates the degree of portosystemic circulation shunting.Blood tests,serum biochemistry tests,abdominal ultrasonography,gastroscopy and examination of clinical features such as the occurrence of varices,bleeding and hepatic encephalopathy were performed.Multivariate analysis was used to identify independent risk factors for complications.We compared the cumulative incidence rates of complications during the follow-up period.RESULTS:The thallium scan shunt index was significantly higher in the decompensated liver cirrhosis group than in the compensated liver cirrhosis group(0.91±0.39 vs 0.39±0.32,P<0.001).It was also higher in the varices group,the hepatic encephalopathy group,and the variceal bleeding group than in the control group(P<0.001).Multivariate analysis showed that the index was an independent risk factor for predicting decompensated liver cirrhosis.When the cut-off value was 0.75,the shunt index had a sensitivity of 82.6%,a specificity of 84%,a positive predictive value of 61.5%,and a negative predictive value of 94.4%in diagnosing decompensated cirrhosis.When the shunt index was greater than 0.75,there was a significant increase in the number of decompensated events.CONCLUSION:The thallium shunt index is a good predictor of cirrhosis-related complications.