Quantitative evaluation of the hepatic functional reserve using technetium-99m DTPA-galactosyl human serum albumin before and after transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt (TIPS), a new therapeutic method, has been performed widely for the treatment of portal hypertension. TIPS produces a decrease in the portal blood flow to the hepatic parenchyma, which is considered to cause a reduction in hepatic functional reserve. To evaluate the changes in hepatic functional reserve after TIPS, we performed technetium-99m DTPA-galactosyl human serum algumin (99mTc-GSA) hepatic scintigraphy before and after TIPS in eight male patients, ranging in age from 54 to 72 years (mean 62.2 years). Two quantitative indices – blood clearance index (uptake ratio of the heart at 15 min to that at 3 min, HH15) and hepatic accumulation index (uptake ratio of the liver to the liver plus heart at 15 min, LHL15) – were calculated from the time-activity curves of the heart and liver. Early and late uptake constant indices (early and late KU) were also calculated from the time-activity curves of the heart and liver by means of Patlak plot. The values of HH15, LHL15 and late KU deteriorated after TIPS in all patients. Early KU (1–3 min) decreased by more than 55% in two patients who showed a poor prognosis and corresponded well with the status of the portosystemic shunt. It is concluded that 99mTc-GSA hepatic scintigraphy is a useful means of evaluating the degree to which hepatic function is compromised following TIPS. The post-TIPS alterations in HH15, LHL15 and late KU (5–10 min) reflect the changes in hepatic functional reserve, and early KU is a useful index for evaluating the degree of portosystemic shunt.