World J Hepatol. 2014 Apr 27;6(4):251-62. doi: 10.4254/wjh.v6.i4.251.
Nuclear medicine dynamic investigations in the diagnosis of Budd-Chiari syndrome.
World journal of hepatology
Mircea Dragoteanu, Ioan-Adrian Balea, Cecilia-Diana Piglesan
Affiliations
Affiliations
- Mircea Dragoteanu, Ioan-Adrian Balea, Cecilia-Diana Piglesan, Department of Nuclear Medicine, Regional Institute for Gastroenterology and Hepatology, Prof. Dr. Octavian Fodor, 400162 Cluj-Napoca, Romania.
PMID: 24799994
PMCID: PMC4009481 DOI: 10.4254/wjh.v6.i4.251
Abstract
AIM: To investigate the hepatic hemodynamics in the Budd-Chiari syndrome (BCS) using per-rectal portal scintigraphy (PRPS) and liver angioscintigraphy (LAS).
METHODS: Fourteen consecutive patients with BCS were evaluated by PRPS between 2003 and 2012. Ten of them underwent LAS and liver scan (LS) with Tc-99m colloid. Eleven patients had clinical manifestations and three were asymptomatic, incidentally diagnosed at PRPS. The control group included 15 healthy subjects. We used new parameters at PRPS, the liver transit time of portal inflow and the blood circulation time between the right heart and liver. PRPS offered information on the hepatic areas missing venous outflow or portal inflow, length and extent of the lesions, open portosystemic shunts (PSS), involvement of the caudate lobe (CL) as an intrahepatic shunt and flow reversal in the splenic vein. LAS was useful in the differential diagnosis between the BCS and portal obstructions, highlighting the hepatic artery buffer response and reversed portal flow. LS offered complementary data, especially on the CL.
RESULTS: We described three hemodynamic categories of the BCS with several subtypes and stages, based on the finding that perfusion changes depend on the initial number and succession in time of the hepatic veins (HVs) obstructions. Obstruction of one hepatic vein (HV) did not cause opening of PSS. The BCS debuted by common obstruction of two HVs had different hemodynamic aspects in acute and chronic stages after subsequent obstruction of the third HV. In chronic stages, obstruction of two HVs resulted in opening of PSS. The BCS, determined by thrombosis of the terminal part of the inferior vena cava, presented in the acute stage with open PSS with low speed flow. At least several weeks are required in the obstructions of two or three HVs for the spontaneous opening of dynamically efficient PSS. The CL seems to have only a transient important role of intrahepatic shunt in several types of the BCS.
CONCLUSION: Dynamic nuclear medicine investigations assess the extent and length of hepatic venous obstructions, open collaterals, areas without portal inflow, hemodynamic function of the CL and reverse venous flow.
Keywords: Budd-Chiari syndrome; Caudate lobe; Hepatic veins; Liver angioscintigraphy; Per-rectal portal scintigraphy
References
- Can J Gastroenterol. 2011 Jun;25(6):302-3 - PubMed
- J Gastroenterol. 1998 Aug;33(4):517-22 - PubMed
- Br J Surg. 1985 Feb;72(2):128-30 - PubMed
- Gut. 1986 Sep;27(9):1101-5 - PubMed
- World J Gastroenterol. 2008 Jun 28;14(24):3841-8 - PubMed
- Ann Radiol (Paris). 1991;34(6-7):362-8 - PubMed
- Am J Gastroenterol. 1995 Mar;90(3):460-5 - PubMed
- Mayo Clin Proc. 1990 Jan;65(1):51-5 - PubMed
- Ann Surg. 2000 Sep;232(3):340-52 - PubMed
- Abdom Imaging. 2011 Aug;36(4):399-406 - PubMed
- AJR Am J Roentgenol. 2003 Dec;181(6):1641-5 - PubMed
- Indian J Gastroenterol. 2009 Jan-Feb;28(1):17-23 - PubMed
- Abdom Imaging. 1994 Jul-Aug;19(4):325-9 - PubMed
- Hepatobiliary Pancreat Dis Int. 2012 Aug 15;11(4):429-33 - PubMed
- Rom J Gastroenterol. 2004 Dec;13(4):351-7 - PubMed
- AJR Am J Roentgenol. 1992 Jul;159(1):113-6 - PubMed
- Ann Intern Med. 2009 Aug 4;151(3):167-75 - PubMed
- Mediterr J Hematol Infect Dis. 2011;3(1):e2011063 - PubMed
- J Hepatol. 2003 Mar;38(3):364-71 - PubMed
- Abdom Imaging. 2003 Sep-Oct;28(5):668-74 - PubMed
- Rom J Gastroenterol. 2004 Mar;13(1):55-63 - PubMed
- Radiology. 1987 Nov;165(2):409-13 - PubMed
- J Hepatol. 2001 Sep;35(3):338-43 - PubMed
- J Hepatol. 2008 Oct;49(4):572-80 - PubMed
- Gastroenterology. 1994 Apr;106(4):1042-7 - PubMed
- Semin Ultrasound CT MR. 1995 Feb;16(1):34-48 - PubMed
- Gut. 1987 Mar;28(3):242-7 - PubMed
- J Hepatol. 2009 Jan;50(1):195-203 - PubMed
- Radiology. 1995 Apr;195(1):117-21 - PubMed
- World J Radiol. 2011 Jul 28;3(7):169-77 - PubMed
- Surg Oncol Clin N Am. 2002 Oct;11(4):835-48 - PubMed
- Semin Liver Dis. 2008 Aug;28(3):259-69 - PubMed
- World J Surg. 2012 Jan;36(1):120-4 - PubMed
- J Gastroenterol Hepatol. 1999 Sep;14(9):904-7 - PubMed
- Surg Radiol Anat. 2008 May;30(3):201-7 - PubMed
Publication Types