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| 1 | Staging of portal hypertension and portosystemic shunts using dynamic nuclear medicine investigations显示文摘AIM: To explore portal hypertension and portosys-temic shunts and to stage chronic liver disease (CLD) based on the pathophysiology of portal hemodynam-ics. METHODS: Per-rectal portal scintigraphy (PRPS) was performed on 312 patients with CLD and liver angio-scintigraphy (LAS) on 231 of them. The control group included 25 healthy subjects. We developed a new model of PRPS interpretation by introducing two new parameters,the liver transit time (LTT) and the circu-lation time between right heart and liver (RHLT). LTT for each lobe was used to evaluate the early portal hypertension. RHLT is useful in cirrhosis to detect liver areas missing portal in? ow. We calculated the classical per-rectal portal shunt index (PRSI) at PRPS and the hepatic perfusion index (HPI) at LAS. RESULTS: The normal LTT value was 24 ± 1 s. Abnor-mal LTT had PPV = 100% for CLD. Twenty-seven non-cirrhotic patients had LTT increased up to 35 s (median 27 s). RHLT (42 ± 1 s) was not related to liver disease. Cirrhosis could be excluded in all patients with PRSI < 5% (P < 0.01). PRSI > 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the clas-sifi cation of CLD in 5 hemodynamic stages. Stage 0 is normal (LTT = 24 s,PRSI < 5%). In stage 1,LTT is increased,while PRSI remains normal. In stage 2,LTT is decreased between 16 s and 23 s,whereas PRSI is increased between 5% and 10%. In stage 3,PRSI is increased to 10%-30%,and LTT becomes undetect-able by PRPS due to the portosystemic shunts. Stage 4 includes the patients with PRSI > 30%. RHLT and HPI were used to subtype stage 4. In our study stage 0 had NPV = 100% for CLD,stage 1 had PPV = 100% for non-cirrhotic CLD,stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis,stage 4 had PPV = 100% for cirrhosis. CONCLUSION: LTT allows the detection of early por-tal hypertension and of opening of transhepatic shunts. PRSI is useful in CLD with extrahepatic portosystemic shunts. Our hemodynamic model stages the evolution of portal hypertension and portosystemic shunts. It may be of use in the selection of patients for interferon therapy. | Mircea Dragoteanu Ioan A Balea Liliana A Dina Cecilia D Piglesan Ioana Grigorescu Stefan Tamas Sabin O Cotul | 2008 | World Journal of Gastroenterology2008，14，24： | 7 |
| 2 | 直肠699mTcO4-门肠闪烁成像观察门奇静脉断流术对门静脉血液循环及门体分流的影响显示文摘本研究采用直肠^99mTcO4-门肠闪烁成像方法观察门奇静脉断流术前和术后门静脉高压症患者的门静脉压力、门静脉血液循环及门体分流的情况。 | 姚常柏 吴硕东 夏振龙 于树鹏 | 2009 | 中华普通外科杂志2009，24，4： | 0 |
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