Zhao H, Tsauo J, Zhang XW, Ma HY, Weng NN, Tang GS, Li X. Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake. World J Gastroenterol 2020; 26(10): 1088-1097 [PMID: 32205999 DOI: 10.3748/wjg.v26.i10.1088]
Corresponding Author of This Article
Xiao Li, MD, PhD, Doctor, Postdoc, Professor, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. simonlixiao@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
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Zhao H, Tsauo J, Zhang XW, Ma HY, Weng NN, Tang GS, Li X. Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake. World J Gastroenterol 2020; 26(10): 1088-1097 [PMID: 32205999 DOI: 10.3748/wjg.v26.i10.1088]
World J Gastroenterol. Mar 14, 2020; 26(10): 1088-1097 Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1088
Technetium-99m-labeled macroaggregated albumin lung perfusion scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake
He Zhao, Jiaywei Tsauo, Xiao-Wu Zhang, Huai-Yuan Ma, Ning-Na Weng, Gong-Shun Tang, Xiao Li
He Zhao, Jiaywei Tsauo, Xiao-Wu Zhang, Xiao Li, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
He Zhao, Huai-Yuan Ma, Ning-Na Weng, Xiao Li, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Gong-Shun Tang, Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhao H, Tsauo J, Weng NN, Zhang XW and Tang GS performed the research; Ma HY analyzed the data; Li X and Tsauo J designed and coordinated the research; Zhao H wrote the paper.
Supported byNational Key R and D Program of China, No. 2017YFC0107800; CAMS Initiative for Innovative Medicine, No. 2016-12M-2-004.
Institutional review board statement: This prospective study was approved by the institutional review board of West China Hospital (Identifier, 2014-234).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
CONSORT 2010 statement: The guidelines of the CONSORT 2010 Statement have been adopted.
Corresponding author: Xiao Li, MD, PhD, Doctor, Postdoc, Professor, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. simonlixiao@gmail.com
Received: November 14, 2019 Peer-review started: November 14, 2019 First decision: December 30, 2019 Revised: January 6, 2020 Accepted: January 19, 2020 Article in press: January 19, 2020 Published online: March 14, 2020 Processing time: 121 Days and 12 Hours
ARTICLE HIGHLIGHTS
Research background
Hepatopulmonary syndrome (HPS) is a common complication of liver disease that impairs the lungs’ ability to oxygenate blood, leading to debilitating symptoms, such as shortness of breath. Intrapulmonary vascular dilations (IPVD), a hallmark of HPS, can be detected using technetium-99m-labeled macroaggregated albumin lung perfusion scan.
Research motivation
Of the two most commonly used methods of result interpretation (i.e., brain uptake and whole-body uptake) for macroaggregated albumin lung perfusion scan, it is unclear which is more accurate for detecting IPVD and diagnosing HPS.
Research objectives
This study aimed to compare brain and whole-body uptake of technetium for diagnosing HPS and establish the standard technique for calculating the shunt fraction for the future research.
Research methods
Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included. Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs, respectively.
Research results
Thirty-two (46%) patients had IPVD as detected by contrast-enhanced echocardiography. The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54; P = 0.025). The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7% and 42.5%, respectively. The sensitivity, specificity, and accuracy of brain uptake > 5.7% and whole-body uptake > 42.5% for detecting IPVD were 23%, 89%, and 59% and 100%, 52%, and 74%, respectively.
Research conclusions
Whole-body uptake is superior to brain uptake for diagnosing HPS.
Research perspectives
Whole-body uptake is superior to brain uptake for diagnosing HPS. Further studies are needed to confirm the findings of the current study. For detecting IPVD and diagnosing HPS, whole-body uptake should be considered as the standard technique for calculating the shunt fraction from macroaggregated albumin lung perfusion scan.
