Portal venous-total hepatic flow ratio by radionuclide angiography

Abstract

Quantitating portal perfusion of cirrhotic liver is important to surgeons preoperatively selecting shunt ‘procedures and postoperatively evaluating the results of shunting. The ideal method for measuring the portal fraction of total hepatic flow should be noninvasive, technically suitable for widespread use, and accurate in the presence of hepatocellular disease [3]. At the present, there are no methods that fulfill all these criteria. Portal perfusion has not been satisfactorily evaluated in the awake human subject because of difficulty evaluating the dual blood supply to the liver, impaired extraction capacity of diseased liver, and the anatomic inaccessibility of the portal vein. Shunt procedures are performed to control variceal hemorrhage. However, an unacceptably high incidence of disabling hepatic encephalopathy has been reported following total or nonselective shunts. Selective shunts (distal splenorenal shunts) have the lowest incidence of postoperative encephalopathy and are as effective as total shunts for preventing recurrent variceal hemorrhage. [ 93, Recently, however, several papers have questioned the efficacy of selective shunting maintaining portal perfusion in the years