A new method of functional scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin.

Background/aims: We investigated whether a new method for scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin could visualize the portal venous system and simultaneously assess hepatic function.

Methodology: Thirty-two patients underwent scintiphotosplenoportography, including 4 with metastatic tumor in an otherwise normal liver, 5 with chronic hepatitis, 9 with cirrhosis, and 14 with both hepatocellular carcinoma and cirrhosis. The tracer (3 mg, 185 MBq) was injected into the spleen under ultrasonic guidance. Hepatic function was evaluated using the receptor index and the index of blood clearance, both calculated by regions of interest for liver and for heart. Spleen-to-liver times were calculated by subtracting peak activity times over the spleen from those over the portal vein.

Results: Correlations of blood clearance and receptor indices with plasma retention rate of indocyanine green at 15 min (respectively, r = 0.616, P < 0.0005 and r = -0.669, P < 0.0001), prothrombin time (r = -0.605, P < 0.0005 and r = 0.710, P < 0.0001), the hepaplastin test (r = -0.526, P < 0.005 and r = 0.605, P < 0.0005), serum albumin (r = -0.488, P < 0.005 and r = 0.640, P < 0.0001), and serum cholinesterase (r = -0.600, P < 0.0005 and r = 0.671, P < 0.0001) were significant. Blood clearance and receptor indices also were significantly related to clinical stage, underlying liver disease, features of radioisotopic images, and presence of esophagogastric varices (P < 0.01). Additionally spleen-to-liver time reflected progressive hepatic damage.

Conclusions: Our new method of scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin can assess hepatic function and portal hemodynamics simultaneously. Results correlate with accepted, conventional diagnostic techniques. This method represents a potent new method for evaluating the hepatic system.