Abstract
The hemodynamic changes in portosystemic collaterals before and after endoscopic injection sclerotherapy (EIS) for the esophageal varices were studied by single photon emission CT (SPECT), scintiphotosplenoportography (SSP), and/or rectal administration of 123I-iodoamphetamine (IMP) in 33 patients with liver cirrhosis. SPECT was performed for the intra-abdominal blood pool with 99mTc(740MBq) autologous red blood cells (RBC). Using SSP by injection of 740MBq of 99mTc-MAA into the spleen, flow patterns of portal circulation and portosystemic shunt index were evaluated. Portosystemic shunt index was calculated using the follow equation. Shunt Index = Counts of Lung/Counts of (Liver + Lung) × 100 In the case of rectal administration of I-123 IMP (TRP), shunt index was calculated using the same equation employed in SSP study. In SPELT study, before EIS, blood pool images of coronary vein were demonstrated in 26 of 29 patients. In 4 of 29 patients, short gastric vein, spleno (gastro)-renal shunt, or paraumbilical vein were demonstrated. After EIS, the blood pool of coronary vein was eliminated or decreased in 16 of 26 patients. In 2 of 4 patients, the pool of short gastric vein was decreased. In 3 patients, the blood pool of spleno-renal shunt or paraumbilical vein was increased after EIS. In SSP study, the coronary vein was visualized before EIS in 12 of 13 patients. After EIS, the coronary vein was disappeared in 9 patients and decreased in 2 patients. The shunt index was increased in all 8 patients after EIS. In TRP study, there was no consistent tendency of changes of shunt index before and after EIS. Therefore, it is considered that SPECT and SSP studies are clinically useful for evaluating the hemodynamic changes of portal circulation before and after EIS.
