Usefulness of scintigraphy with technetium-99m galactosyl human serum albumin in prediction of prognosis of primary biliary cirrhosis

Abstract

Prediction of survival of patients with primary biliary cirrhosis (PBC) has been based on results of blood tests and other indices of clinical condition, which may be affected by treatment. We earlier evaluated hepatic receptor imaging with 99mTc galactosyl human serum albumin as an alternative method for prediction of survival. To evaluate whether this method is useful for this purpose, we examined the cumulative survival rate of patients with PBC since their first examination by this method. The subjects were 60 patients with PBC, 10 healthy subjects, 65 patients with chronic hepatitis, and 196 patients with cirrhosis. Computer acquisition of gamma-camera data was started just before the injection of 99mTc galactosyl human serum albumin and was stopped 20 min later. As indices of hepatic functional reserve, the receptor index and the index of blood clearance were calculated. Among the patients with PBC, the receptor index was lower in those with stage IV than in those with stages I, II, or III, and the index of blood clearance was higher in patients with stage IV than in those with stages I, II, or III. On the basis of the receptor index, the patients with PBC were divided arbitrarily into two groups of roughly equal size: group A with a receptor index of ≥0.94, and group B with index <0.94. On the basis of the index of blood clearance, the patients were also divided into two groups of roughly equal size: group C with an index of blood clearance of <0.52, and group D with index ≥0.52. Cumulative survival rates were significantly lower in group B than in group A ( P=0.026), and lower in group D than in group C ( P=0.005). Regression analysis showed the index of blood clearance to be significantly related to survival. In conclusion, hepatic receptor imaging with 99mTc galactosyl human serum albumin can be used to noninvasively evaluate the hepatic functional reserve of patients with PBC and is useful clinically in establishing their prognosis.