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