Abstract
Objective: End-stage chronic liver disease (CLD) adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS) findings in liver transplant (LT) candidates with end-stage CLD.Methods: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe.Results: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and one had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%); bilateral decrease in lower extremity uptake (n=26, 56.5%); symmetrically increased periarticular uptake (n=26, 56.5%); bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA) (n=8, 17.4%); bilateral increased sacroiliac activity (n=16, 34.8%); sacral activity (n=10, 21.7%), coccygeal activity (n=2, 4.3%), focally increased uptake suggestive of metastases (n=5, 10.9%). Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7%) and bilateral diffuse mild or severe degree of renal cortical uptake (n=20, 43.5%). There was a statistically significant difference in serum creatinine values between mild and severe renal uptake groups (p<0.05). There was also statistically significant difference in serum BUN and creatinine values between patients with severe degree of renal uptake and without renal uptake (p<0.05).Conclusion: The results of the current study has shown that adolescent LT candidates with end-stage CLD had no osseous abnormality on BS. However, all of adult patients exhibited one or one more osseous abnormalities. Typical scintigraphic findings denoting to abnormalities in bone metabolism were generalized decreased osseous uptake, decreased lower extremity osseous uptake, increased periarticular uptake, increased cortical/periosteal uptake indicating hepatic HOA, and other unusual uptake patterns. Hepatocellular carcinoma metastases may present itself as rib metastases linear in pattern. Soft-tissue uptake in the form of diffuse bilateral mild or severe degree of renal uptake and less commonly mild diffuse liver uptake can be observed. Increased renal uptake may be an early marker of renal dysfuntion or a predictor of hepatorenal syndrome. Conflict of interest:None declared.
Highlights
Abnormalities in bone metabolism observed in chronic liver disease (CLD) are referred to as hepatic osteodystrophy (HO), which includes osteoporosis and, less frequently, osteomalacia
Typical scintigraphic findings denoting to bone metabolism abnormalities were the presence of decreased osseous uptake, increased periarticular uptake, increased cortical/periosteal uptake suggesting hepatic hypertrophic osteoarthropathy (HOA) and unusual uptake patterns including sacroiliac, sacral and coccygeal activity
The results of the current study haves shown that adolescent liver transplantation (LT) candidates with end-stage CLD had no osseous abnormality on bone scintigraphy (BS)
Summary
Abnormalities in bone metabolism observed in chronic liver disease (CLD) are referred to as hepatic osteodystrophy (HO), which includes osteoporosis and, less frequently, osteomalacia. The prevalence of bone disease has been reported in previous studies to range between 12% and 55% among patients with liver cirrhosis [1,2,3,4]. Following liver transplantation (LT), the fracture risk is further increased due to the use of high steroid doses and prolonged immobility, when complications arise after surgery. Bone disease in patients with CLD have a significant impact on morbidity causing fractures that may result in chronic pain, longlasting immobility, and deformity. Routine bone status assessment should be performed in all patients with CLD in order to minimize the bone loss and decrease the fracture risk after transplantation
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