Hepatopulmonary Syndrome with Right-to-left Shunt in Cirrhotic Patients Using Macro-Aggregated Albumin Lung Perfusion Scan: Comparison with Contrast Echocardiography and Association with Clinical Data

Objectives: The diagnosis of hepatopulmonary syndrome (HPS) which is a common complication in cirrhotic patients is still subject to debate. This study investigated the association of clinical findings with HPS in cirrhotic patients using macro-aggregated albumin lung perfusion scan (99mTcMAA lung scintigraphy). In addition, comparison between 99mTc-MAA lung scintigraphy and contrast echocardiography (CEE) in detection of HPS was also performed. Methods: In this study, 27 patients with cirrhosis underwent 99mTc-MAA lung scintigraphy and contrast echocardiography comparison CEE and the frequency of HPS was assessed in them and also was compared across the other variables. Results: The 99mTc-MAA lung scintigraphy showed HPS in 13 patients (48.1%) while CEE demonstrated HPS in 5 patients with cirrhosis (18.51%). HPS was mild in 40.74% (11/27) of the patients, and severe in only 2 patients. There was no relationship between gender, disease duration, having diagnosis of disease previously, pulmonary symptoms and Child-Pugh score variations and HPS (p>0.05). Comparison of hemodynamic indices, arterial blood gas analysis and laboratory indices between patients with and without HPS was also non-significant (p value >0.05). Among coagulation factors assessed in cirrhotic patients, we found only significant correlation between HPS and prothrombin time (p

Sirotik Hastalardaki Sağ-Sol Şant ile İlişkili Hepatopulmoner Sendromun Tanısında MakroAgregant Albümin Akciğer Perfüzyon Sintigrafisinin Kontrast Ekokardiyografi ile Karşılaştırılması ve Klinik Veriler ile İlişkisi

Amaç: Sirotik hastalarda sık görülen bir komplikasyon olan hepatopulmoner sendromun (HPS) tanısı halen tartışmaya açıktır. Bu çalışmada, makroagregat albümin akciğer perfüzyon sintigrafisi (99mTc-MAA akciğer sintigrafisi) kullanılarak sirotik hastalarda klinik bulgularla HPS’nin ilişkisi araştırılmıştır. Ayrıca, HPS’nin saptanmasında 99mTc-MAA akciğer sintigrafisi ile kontrast ekokardiyografi (KE) karşılaştırılmıştır. Yöntem: Bu çalışmada, sirozlu 27 hastada 99mTc-MAA akciğer sintigrafisi ve KE karşılaştırıldı ve HPS sıklığı değerlendirildi. Ayrıca HPS’nin sıklığı ile diğer değişkenler arasındaki ilişki araştırıldı. Bulgular: 99mTc-MAA akciğer sintigrafisi 13 sirozlu hastada (%48,1) HPS’nin varlığını gösterirken, KE 5 sirozlu hastada (%18,51) gösterdi. HPS hastaların %40,74’inde (11/27) hafif, sadece 2 hastada şiddetliydi. Cinsiyet, hastalık süresi, hastalık geçmişi, akciğer semptomları ve Child skoru ile HPS arasında herhangi bir ilişki yoktu (p>0,05). Hemodinamik indeksler, arteriyel kan gazı analizi ve laboratuvar indeksleri açısından HPS’li hastalar ve HPS’li olmayan hastalar arasında fark görülmedi (p>0,05). Sirotik hastalarda değerlendirilen koagülasyon faktörleri arasında, sadece HPS ve protrombin zamanı arasında anlamlı bir korelasyon bulundu (p

Kaynakça

Lima BL, França AV, Pazin-Filho A, Araújo WM, Martinez JA, Maciel BC, Simões MV, Terra-Filho J, Martinelli AL. Frequency, clinical characteristics, and respiratory parameter of hepatopulmonay Syndrome. Mayo Clin Proc 2004;79:42-48.

Schen KP, Falrmaannn V, Madl C, Funk G, Lehr S, Kandel O, Müller C. Hepatopulmonary syndrome: prevalence and predictive value of various cut off for arterial oxygenation and their clinical consequences. Gut 2002;51:853-859.

Hira HS, Kumaj T, Tyagi SK, Jain SK. A study of hepatopulmonary syndrome among patient of cirrhosis of liver and portal hypertension. Indian J Chest Dis Allied Sci 2003;45:165-171.

Anond AC, Malcheryee D, Rao KS, Seth AK. Hepatopulmonary syndrome; prevalence and clinical profile. Indian J Gastroenterol 2001;20:24-27.

Fallon MB, Abrams GA. Pulmonary dysfunction in chronic disease. Hepatology 2000;32:859-865.

Przybyowski T, Krenke R, Fangrat A, Nasilowski J, Grabczak EM, Styczynskg G, Pruszczyk P, Krawczyk M, Chazan R. Gas exchange abnormalities in patients listed forliver transplantation. J Physiol Pharmacol 2006;57 Suppl 4:313-323.

Flukiger M. Occurrence of club-shaped finger phalanges without chronicchanges in the lungs or heart. Wien Med Wochenschr 1884;34:1457-1458.

Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB. Pulmonary hepatic vascular disorders (PHD). Eur Respir J 2004; 24:861-80.

Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995;109:1283-1288.

10. Abrams GA, Nanda NC, Dubovsky EV, Krowka MJ, Fallon MB. Use of macro-aggregated albumin lung perfusion scan to diagnose hepatopulmonary syndrome: a new approach. Gastroenterology 1998;114:305-310.

11. Gupta NA, Abramowsky C, Pillen T, Redd D, Fasola C, Heffron T, Romero R. Pediatric hepatopulmonarys Syndrome is seen with polysplenia/ interrupted inferior vena cava and without cirrhosis. Liver Transpl 2007;13:680-686.

12. Swanson KL,Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: impact of liver transplantation. Hepatology 2005;41:11221129.

13. Noli K, Solomon M, Golding F, Charron F, Ling SC. Prevalence of hepatopulmonary syndrome in children. Pediatrics 2008;121:522-527.

14. Surasi DS, Manapragada P, Bhambhvani P. Lung perfusion imaging in hepatopulmonary syndrome using (99m)Tc macroaggregated albumin. J Nucl Cardiol 2015;22:586-588.

15. El-Shabrawi MH, Omran S, Wageeh S, Isa M, Okasha S, Mohsen NA, Zekry O, E-Bartan G, El-Karaksy HM. (99m)Technetium-macroaggregated albumin perfusion lung scan versus contrast enhanced echocardiography in the diagnosis of the hepatopulmonary syndrome in children with chronic liver disease. Eur J Gastroenterol Hepatol 2010;22:1006-1012.

16. Kalambokis G, Tsianos EV. Lung perfusion scan is not superior to contrast-enhanced echocardiography for thediagnosis of the hepatopulmonary syndromein chronic liver disease. Eur J Gastroenterol Hepatol 2010;22:1387-1388.

17. Grimon G, André L, Bernard O, Raffestin B, Desgrez A. Early radionuclide detection of intrapulmonary shunts in children with liver disease. J Nucl Med 1994;35:1328-1332.

18. Fatemi R, Alizadeh AM, Mirzaei V, Khoshbaten M, Talebbipour B, Sharifian A, et al. Clinical and diagnostic characteristics of hepatopulmonary syndrome among Iranian patients with cirrhosis. Research in Medicine. 2005;29:175-178.

19. FauciA, Kasper D, Hauser S, Longo D, Jameson L, Loscalzo J. Harrison’s Principles of Internal medicine.18nd ed. New-York; McGraw Hill; 2012.p.1891-1999.

20. Fragaki M, Sifaki-Pistolla D, Samonakis DN, Koulentaki M, Koukouraki S, Stathaki M, Kouroumalis E. Screening for Hepatopulmonary Syndrome in Cirrhotic Patients Using Technetium 99m-macroaggregated Albumin Perfusion Lung Scan (Tc-MAA): Diagnostic Approach and Clinical Correlations. J Clin Gastroenterol 2018;52:828-834

21. Grilo I, Pascasio JM, Tirado JL, López-Pardo FJ, Ortega-Ruiz F, Sousa JM, Rodríguez-Puras MJ, Ferrer MT, Gómez-Bravo MÁ, Grilo Reina A. The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation. Rev Esp Enferm Dig 2017;109:335-343.

Kaynak Göster

Molecular Imaging and Radionuclide Therapy
  • ISSN: 2146-1414
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 1992

1.3b495

Sayıdaki Diğer Makaleler

Four Atypical Parathyroid Adenomas Detected by Dual Phase Tc-99m MIBI SPECT

Mine ARAZ, Derya ÇAYIR, Fatma Fulya KÖYBAŞIOĞLU, Harun KARABACAK, Erman ÇAKAL

Metabolic Characteristics and Diagnostic Contribution of 18F-FDG PET/CT in Gastric Carcinomas

Esra ARSLAN, Tamer AKSOY, Cihan GÜNDOĞAN, Çiğdem ŞEN, Selda YILMAZ TATAR, NEVRA DURSUN, Tevfik Fikret ÇERMİK

Increased Bone Marrow 18F-Choline Uptake in a Patient with Hepatocellular Carcinoma and Thalassemia Intermedia

Luca FİLİPPİ

Amyloidosis Associated Kidney Failure with Gross Hypermetabolic Intra-abdominal Mass

Zehra Pınar KOÇ, Pelin ÖZCAN KARA, Kenan TURGUTALP, Kaan ESEN, TUBA KARA

18F-NaF PET/CT and Extraordinary Involvement: Non-calcific Brain Involvement in a Prostate Cancer Case

Ulku KORKMAZ, Funda USTUN

Hepatopulmonary Syndrome with Right-to-left Shunt in Cirrhotic Patients Using Macro-Aggregated Albumin Lung Perfusion Scan: Comparison with Contrast Echocardiography and Association with Clinical Data

Zeynab ALİPOUR, Abbas ARMİN, Sudabeh MOHAMADİ, Seyed Masoud TABİB, Zahra AZİZMOHAMMADİ, Ali GHOLAMREZANEZHAD, Majid ASSADİ

The Prognostic Value of 18F-FDG PET/CT and KRAS Mutation in Colorectal Cancers

Esra ARSLAN, Tamer AKSOY, Rıza Umar GÜRSU, NEVRA DURSUN, Ekrem ÇAKAR, Tevfik Fikret ÇERMİK

Esophageal Clearance in Laryngopharyngeal Reflux Disease: Correlation of Reflux Scintigraphy and 24-hour Impedance/pH in a Cohort of Refractory Symptomatic Patients

Leticia BURTON, Gregory L. FALK, Karl BAUMGART, John BEATTİE, Scott SİMPSON, Hans Van Der WALL