Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2020; 26(10): 1088-1097
Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1088
Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake
He Zhao, Jiaywei Tsauo, Xiao-Wu Zhang, Huai-Yuan Ma, Ning-Na Weng, Gong-Shun Tang, Xiao Li
He Zhao, Jiaywei Tsauo, Xiao-Wu Zhang, Xiao Li, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
He Zhao, Huai-Yuan Ma, Ning-Na Weng, Xiao Li, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Gong-Shun Tang, Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhao H, Tsauo J, Weng NN, Zhang XW and Tang GS performed the research; Ma HY analyzed the data; Li X and Tsauo J designed and coordinated the research; Zhao H wrote the paper.
Supported by National Key R and D Program of China, No. 2017YFC0107800; CAMS Initiative for Innovative Medicine, No. 2016-12M-2-004.
Institutional review board statement: This prospective study was approved by the institutional review board of West China Hospital (Identifier, 2014-234).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
CONSORT 2010 statement: The guidelines of the CONSORT 2010 Statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao Li, MD, PhD, Doctor, Postdoc, Professor, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. simonlixiao@gmail.com
Received: November 14, 2019
Peer-review started: November 14, 2019
First decision: December 30, 2019
Revised: January 6, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: March 14, 2020
Abstract
BACKGROUND

Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension. This syndrome occurs most often in cirrhotic patients (4%–32%) and has been shown to be detrimental to functional status, quality of life, and survival. The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e., diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects, preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient, respectively.

AIM

To compare brain and whole-body uptake of technetium for diagnosing HPS.

METHODS

Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included. Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs, respectively.

RESULTS

Thirty-two (46%) patients had IPVD as detected by contrast-enhanced echocardiography. The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71 ± 0.18 mg/dL vs 0.83 ± 0.23 mg/dL; P = 0.041), alveolar-arterial oxygen gradient (23.2 ± 13.3 mmHg vs 16.4 ± 14.1 mmHg; P = 0.043), and arterial partial pressure of oxygen (81.0 ± 12.1 mmHg vs 90.1 ± 12.8 mmHg; P = 0.004). Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0% ± 6.1% vs 40.1% ± 8.1%; P = 0.001). The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54; P = 0.025). The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7% and 42.5%, respectively, based on Youden’s index. The sensitivity, specificity, and accuracy of brain uptake > 5.7% and whole-body uptake > 42.5% for detecting IPVD were 23%, 89%, and 59% and 100%, 52%, and 74%, respectively.

CONCLUSION

Whole-body uptake is superior to brain uptake for diagnosing HPS.

Keywords: Portal hypertension, Intrapulmonary vascular dilations, Radionuclide imaging, Technetium-99m-labeled macroaggregated albumin lung perfusion scan, Diagnostic tests, Sensitivity and specificity

Core tip: Hepatopulmonary syndrome is a common complication of liver disease that impairs the lungs’ ability to oxygenate blood, leading to debilitating symptoms, such as shortness of breath. Intrapulmonary vascular dilations, a hallmark of hepatopulmonary syndrome, can be detected using technetium-99m-labeled macroaggregated albumin lung perfusion scan; however, of the two most commonly used methods of result interpretation (i.e., brain uptake and whole-body uptake), it is unclear which is more accurate. In this study of 69 patients with liver cirrhosis, we found that whole-body uptake is more accurate than brain uptake for detecting intrapulmonary vascular dilations.