Bernardo Times de Carvalho1, Ana Lúcia Coutinho Domingues2, Edmundo Pessoa de Almeida Lopes3, Simone Cristina Soares Brandão3. 1. General Hospital, Federal University of Pernambuco, Av. Agamenon Magalhaes 4760 Paissandu - Recife/PE. Ed Joao de Deus 1º andar sala 3, Recife, 52050-902, Brazil. b.timesc@gmail.com. 2. General Hospital, Federal University of Pernambuco, Av. Agamenon Magalhaes 4760 Paissandu - Recife/PE. Ed Joao de Deus 1º andar sala 3, Recife, 52050-902, Brazil. 3. General Hospital, Federal University of Pernambuco, Av. Moraes Rego, 1235 - Cidade Universitaria, Recife, Pernambuco, 50670-901, Brazil.
Abstract
BACKGROUND: Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS). AIMS: This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS. METHODS: Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed. RESULTS: It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p = 0.0029) and that this increase correlated with splenic length (p = 0.038) and diameter of esophageal varices (p = 0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices. CONCLUSIONS: Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.
BACKGROUND: Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS). AIMS: This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS. METHODS: Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed. RESULTS: It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p = 0.0029) and that this increase correlated with splenic length (p = 0.038) and diameter of esophageal varices (p = 0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices. CONCLUSIONS: Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhoticpatients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.
Authors: Alexander Zipprich; Norbert Steudel; Curd Behrmann; Frank Meiss; Ursula Sziegoleit; Wolfgang E Fleig; Gerhard Kleber Journal: Hepatology Date: 2003-02 Impact factor: 17.425