(99m)Tc-phytate trans-splenic portal scintigraphy in the diagnosis of cirrhotic portal hypertension and compensatory circulation.

Abstract

The trans-splenic portal scintigraphy (TPS) was evaluated as a diagnostic tool in the post viral hepatitis cirrhotic patients of various classes of Child Pugh's (CP) classification. The main aim was to determine the portosystemic shunt index (PSSI) and to compare the results with various clinical grades of disease severity in liver cirrhosis. TPS was performed on 72 patients and 10 controls and PSSI was derived. All the 72 patients were categorized according to CP classification into three classes. The cirrhotic patients were categorized as CP A (n=24),CP B (n=22), and CP C (n=26)according to CP criteria. PSSI was compared with different CP classes. In the controlled population, the splenic vein was normal in shape and the mean PSSI was calculated to be 0.178±0.031 (n=10). For CP classes A, B, and C, the mean PSSI was 0.36±0.04, 0.45±0.05, and 0.54±0.04 (n=26), respectively. There was statistical significance among groups (p≤0.01).The collateral vessels were mostly uphill or complex. The PSSI index increased as the CP score worsened from A to C. PSSI is a useful and minimally invasive tool to detect and quantify the shunt severity, which correlates well with different clinical grades of disease severity.