. 2020; 29(1): 1-6

Right-to-left shunt associated with hepatopulmonary syndrome in cirrhotic patients using macro-aggregated albumin lung perfusion scan: Comparison with contrast echocardiography and association with clinical data

Majid Assadi
Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Bushehr Medical University Hospital, Bushehr University of Medical Sciences, Bushehr, Iran

INTRODUCTION: The diagnosis of hepatopulmonary syndrome (HPS) which is a common complication in cirrhosis patients is still subject to debate. This study investigated the association of clinical findings with hepatopulmonary syndrome in cirrhotic patients using macro-aggregated albumin lung perfusion scan ( 99mTc-MAA lung scintigraphy). In addition, comparison between 99mTc-MAA lung scintigraphy and contrast echocardiography comparison (CEE) in detection of HPS was also performed.
METHODS: In this study, 27 patients with cirrhosis underwent 99mTc-MAA lung scintigraphy and contrast echocardiography comparison (CEE) and the frequency of HPS was assessed in them and also was compared across the other variables.
RESULTS: The 99mTc-MAA lung scintigraphy showed HPS in 13 patients (48.1%) while CEE demonstrated HPS in 5 patients with HPS (18.51%). HPS was mild in 84.61% (11/27) of the patients, and severe in only 2 patient. There was no any relationship between gender, disease duration, disease past history, pulmonary symptoms and child score variations and HPS (p>0.05). Comparison of hemodynamic indices, arterial blood gas (ABG) analysis and laboratory indices between patients with and without HPS were also nonsignificant (p value >0.05). Between coagulation factors assessed in cirrhotic patients, we found only significant (P<0.05) correlation between HPS and Prothrombin Time(PTT).
DISCUSSION AND CONCLUSION: Hepatopulmonary syndrome particularly mild form is noted in a great number of patients with cirrhosis using 99mTc-MAA lung scintigraphy. Because of its technical ease, and possibility to obtain objective quantitative information, 99mTc-MAA lung scintigraphy can be complementary to other diagnostic methods in the evaluation of hepatopulmonary syndrome assessment, although additional studies are needed.

Keywords: Hepatopulmonary syndrome (HPS), cirrhosis, macro-aggregated albumin lung perfusion scan ( 99mTc-MAA lung scintigraphy), contrast echocardiography comparison (CEE)


Majid Assadi. Right-to-left shunt associated with hepatopulmonary syndrome in cirrhotic patients using macro-aggregated albumin lung perfusion scan: Comparison with contrast echocardiography and association with clinical data. . 2020; 29(1): 1-6

Corresponding Author: Majid Assadi, Iran


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