Brief Article
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World J Gastroenterol. Jan 7, 2014; 20(1): 228-234
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.228
Assessment of risk of complications in cirrhosis using portal thallium scans
Hye-Jin Tae, Dae-Won Jun, Yun-Young Choi, Min-Jung Kwak, Min-Ho Lee
Hye-Jin Tae, Dae-Won Jun, Min-Ho Lee, Department of Internal Medicine, Hanyang University School of Medicine, Seoul 133-792, South Korea
Yun-Young Choi, Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul 133-792, South Korea
Min-Jung Kwak, Department of Computer Science and Statistics, Pyongtaek University, Pyongtaek 450-701, South Korea
Author contributions: Jun DW had full access to all of the data in the study and tookresponsibility for the integrity of the data and the accuracy of the data analysis; Lee MH conceived the study and design; Choi YY and Kwak MJ analyzed and interpreted data; Tae HJ wrote the manuscript.
Supported by The Research Fund of Hanyang University HY-2011-MC
Correspondence to: Dae-Won Jun, MD, Department of Internal Medicine, Hanyang University School of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-792, South Korea. noshin@hanyang.ac.kr
Telephone: +82-2-22908338 Fax: +82-2-9720068
Received: June 28, 2013
Revised: September 12, 2013
Accepted: September 29, 2013
Published online: January 7, 2014
Processing time: 206 Days and 6.3 Hours
Abstract

AIM: To investigate the usefulness of a novel thallium scan shunt index for assessing portosystemic shunt-related cirrhotic complications.

METHODS: We enrolled 209 chronic hepatitis B-related cirrhosis patients. After rectal thallium instillation, radioactive isotope activity in the heart and liver was measured. The ratio of radiation uptake between the heart and the liver was calculated (the shunt index). This value indicates the degree of portosystemic circulation shunting. Blood tests, serum biochemistry tests, abdominal ultrasonography, gastroscopy and examination of clinical features such as the occurrence of varices, bleeding and hepatic encephalopathy were performed. Multivariate analysis was used to identify independent risk factors for complications. We compared the cumulative incidence rates of complications during the follow-up period.

RESULTS: The thallium scan shunt index was significantly higher in the decompensated liver cirrhosis group than in the compensated liver cirrhosis group (0.91 ± 0.39 vs 0.39 ± 0.32, P < 0.001). It was also higher in the varices group, the hepatic encephalopathy group, and the variceal bleeding group than in the control group (P < 0.001). Multivariate analysis showed that the index was an independent risk factor for predicting decompensated liver cirrhosis. When the cut-off value was 0.75, the shunt index had a sensitivity of 82.6%, a specificity of 84%, a positive predictive value of 61.5%, and a negative predictive value of 94.4% in diagnosing decompensated cirrhosis. When the shunt index was greater than 0.75, there was a significant increase in the number of decompensated events.

CONCLUSION: The thallium shunt index is a good predictor of cirrhosis-related complications.

Keywords: Liver cirrhosis; Portosystemic shunt; Decompensation

Core tip: After rectal thallium instillation, radioactive isotope activity in the heart and liver was measured (the shunt index). It was higher in the varices group, the hepatic encephalopathy group, and the variceal bleeding group than in the control group (P < 0.001). Multivariate analysis showed that the index was an independent risk factor for predicting decompensated liver cirrhosis. When the shunt index was greater than 0.75, there was a significant increase in the number of decompensated events. The thallium shunt index is a good predictor of cirrhosis-related complications.