Per-rectal portal scintigraphy as an alternative measure of hepatic venous pressure gradient in chronic liver disease: a preliminary report.

Aim Hepatic venous pressure gradient (HVPG) measurement is a gold standard for the diagnosis of portal hypertension but can be invasive and difficult to conduct. Per-rectal portal scintigraphy (PRPS) can estimate portal hemodynamics noninvasively. However, no report to date has examined the association between HVPG and PRPS in patients with chronic liver disease, including cirrhosis. Methods This single-center study included a total of 21 patients with chronic liver disease who underwent HVPG measurement and PRPS. For PRPS, the transit times from injection of the radiotracer to its inflow into the liver (TTL) and heart (TTH) were set and the time difference between TTL and TTH (TDLH) was calculated, while the shunt index (SI) was measured. Results Cirrhosis was observed in 18 cases (86%), and the median HVPG was 13 mmHg. HVPG (P = 0.028), TTL (P = 0.018), TDLH (P = 0.003), and SI (P = 0.033) were higher in patients with esophageal varices (EV). Considering the diagnostic ability for EV, the area under the curve was 0.88 for TDLH and 0.80 for HVPG. TDLH was significantly correlated with the risk of EV rupture (P = 0.004). Conclusion Patients with chronic liver disease should undergo upper gastrointestinal endoscopy when the TDLH is high.