Gastroenterology

Gastroenterology

Volume 114, Issue 2, February 1998, Pages 305-310
Gastroenterology

Liver, Pancreas, and Biliary Tract
Use of macroaggregated albumin lung perfusion scan to diagnose hepatopulmonary syndrome: A new approach,☆☆

https://doi.org/10.1016/S0016-5085(98)70481-0Get rights and content

Abstract

Background & Aims: We have reported that contrast echocardiography is a sensitive screening test for the hepatopulmonary syndrome (HPS). However, contrast echocardiography lacks specificity because many cirrhotic patients have positive study results with normal arterial blood gases and therefore do not fulfill criteria for HPS. The aim of this study was to assess the role of macroaggregated albumin lung perfusion scans (MAA scans) in the diagnosis of HPS. Methods: MAA scans were performed in 25 patients with HPS, 25 cirrhotic patients without HPS, and 15 hypoxemic subjects with intrinsic lung disease alone. An MAA shunt fraction was calculated from brain and lung counts. Results: MAA scan results were positive in 21 of 25 patients with HPS and negative in all controls. All 21 patients with positive MAA scans had PO2 values of <60 mm Hg. There was a strong inverse correlation between the degree of the MAA shunt fraction and arterial hypoxemia (r = −0.726). Conclusions: A positive MAA scan result in cirrhosis is specific for the presence of moderate to severe HPS. We speculate that MAA scans may be particularly useful in evaluating the contribution of HPS to the hypoxemia in cirrhotic patients with intrinsic lung disesase.

GASTROENTEROLOGY 1998;114:305-310

Section snippets

Study population

The sensitivity and specificity of MAA scans were assessed in 25 consecutive patients with HPS and 25 normoxemic cirrhotic patients without HPS, 7 of whom had intrapulmonary vasodilatation determined by a positive result on contrast echocardiography (Tables 1 and 2). Fifteen hypoxemic, noncirrhotic subjects with intrinsic lung disease served as controls for cirrhotic patients with concurrent obstructive or restrictive pulmonary disease (Table 3). All patients with HPS fulfilled previously

Sensitivity and specificity of MAA scans

MAA scan results were positive in 21 of 25 subjects with HPS, providing a sensitivity of 84% (Table 1). All 21 subjects with PO2 < 60 mm Hg had positive MAA scans, compared with 4 subjects with mild HPS (PO2 range, 68–91 mm Hg) who had normal MAA results (P < 0.001). Each of the 25 cirrhotic patients without HPS had normal MAA scan results, resulting in a specificity of 100% (Table 2). In addition, all hypoxemic subjects with intrinsic lung disease (mean PO2, 55 ± 2.2 mm Hg; range, 36–67 mm Hg)

Discussion

This study evaluates the role of MAA scans in the diagnosis of HPS. We show in a cohort of patients with HPS that MAA scans identified all subjects with moderate to severe hypoxemia, as defined by a PO2 value of <60 mm Hg, and yielded negative results in all cirrhotic patients without HPS and in all hypoxemic controls with intrinsic lung disease. Thus a positive MAA scan result in the setting of cirrhosis is specific for HPS and may be useful for detection of HPS in hypoxemic cirrhotic patients

Acknowledgements

The authors thank Jane Foster, R.N., Tamara Tutton, R.N., Olinda Argumedo, R.N. (Echocardiography), Arthur Hsiao (Nuclear Medicine), and Sheri McFall (Secretary) for their help.

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Supported in part by a grant from the Pure-Gar Co., Tacoma, Washington.

☆☆

Address requests for reprints to: Gary A. Abrams, M.D., University of Alabama at Birmingham, UAB Liver Center, 401 Zeigler Research Building, 703 South 19th Street, Birmingham, Alabama 35294-0007. Fax: (205) 975-9393.

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