Monitoring Hepatocyte Dysfunction and Biliary Complication After Liver Transplantation Using Quantitative Hepatobiliary Scintigraphy.
Monitoring Hepatocyte Dysfunction and Biliary Complication After Liver Transplantation Using Quantitative Hepatobiliary Scintigraphy.
复制标题
使用定量肝胆闪烁扫描监测肝移植后肝细胞功能障碍和胆道并发症
DOI：
10.1097/md.0000000000002009
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发表时间：
2015-11
期刊：
影响因子：
1.6
通讯作者：
Zhu XH
中科院分区：
文献类型：
--
作者：
Zou SJ;Chen D;Li YZ;Du DF;Chen ZS;Zhu XH
肝胆管造影术（HBS）对移植肝功能评估的意义大多建立在回顾性研究的基础上，由于缺乏定量数据和准确性的差异，HBS的重要性尚未得到广泛认可。为探讨定量HBS评价肝移植术后肝细胞功能障碍和胆道并发症的有效性，对57例原位肝移植术后的受者进行了67次99 mTc-EHIDA动态显像，并对肝细胞提取率（HEF）、达最大放射性时间（Tmax）、计算峰活性下降50%的时间（T1/2）。将基于3个参数的动脉造影结果与最终诊断进行比较。采用ROC曲线分析确定Tmax诊断胆管狭窄的临界值。99 mTc-EHIDA HBS定量检测肝移植术后肝细胞功能异常和胆道并发症的敏感性为94.12%（16/17），特异性为93.33%（42/45），诊断准确性为93.55%（58/62）。Tmax诊断肝移植术后胆管狭窄的临界值设定为15.75 min，敏感性为100.0%，特异性为94.0%。 99 mTc-EHIDA HBS是一种无创性的影像学检查方法，具有较高的敏感性和特异性，可用于肝移植术后肝细胞功能障碍的诊断，并可用于肝移植术后胆道狭窄的鉴别诊断。此外，从动态HBS获得的HEF和Tmax值与常规肝功能参数显示出良好的相关性。
AbstractThe significance of hepatobiliary scintigraphy (HBS) for hepatic graft function assessment was established mostly on retrospective studies and was not widely recognized due to the lack of quantitative data and variation in accuracy. This prospective study was performed to investigate the effectiveness of quantitative HBS for assessing hepatocyte dysfunction and biliary complication in liver transplant recipients.In 57 recipients who had undergone orthotopic liver transplantation, a total of 67 dynamic 99mTc-EHIDA scans were performed and quantitative parameters including the hepatocyte extraction fraction (HEF), time to maximum hepatic radioactivity (Tmax), and time for peak activity to decrease by 50% (T1/2) were calculated. The scintigraphic results based on the 3 parameters were compared against the final diagnosis. A ROC curve analysis was carried out to identify the cutoff value of Tmax for diagnosis of biliary stricture. Correlation between the parameters of postoperative HBS and conventional biochemical liver function indices were also analyzed.Quantitative 99mTc-EHIDA HBS had an overall sensitivity of 94.12% (16/17), specificity of 93.33% (42/45), and diagnostic accuracy of 93.55% (58/62) for detecting hepatocyte dysfunction and biliary complication in liver transplant recipients. The recommended cutoff value of Tmax for diagnosis of post-transplant biliary stricture was set at 15.75 min with a sensitivity of 100.0% and a specificity of 94.0%. The scintigraphic parameters (HEF, Tmax) were statistically significantly associated with the conventional liver function parameters.Quantitative 99mTc-EHIDA HBS offers a noninvasive imaging modality with high sensitivity and specificity to diagnose hepatocyte dysfunction as well as distinguish between patients with or without biliary stricture following liver transplantation. Furthermore, HEF and Tmax values obtained from dynamic HBS show good correlation with conventional liver function parameters.