Abstract
The perfused Kupffer cell mass determines sulfur colloid distribution by liver spleen scan (LSS) and is proportional to the perfused hepatocyte mass. This accounts for the correlation of sulfur colloid distribution with tests of hepatic function and raises the question of whether the LSS can be used as a quantitative test of hepatic function. The recent ability to precisely measure sulfur colloid distribution by single-photon-emission computerized tomography (SPECT) prompted us to evaluate the clinical value in 329 consecutive patients with adequate LSS and clinical information, of which 27 apparent normals and 220 patients with chronic liver disease (CLD) were included in this study. The liver-bone marrow index (LBI) indicated the distribution of counts between the liver and bone marrow. The liver-spleen index (LSI) indicated the distribution between liver and spleen adjusted for spleen size. The LBI and LSI correlated with each other (r=0.753;P<0.001). The arithmetic mean of LBI and LSI was defined as the severity score. Detailed clinical evaluation was available in these patients and included 109 who had liver biopsy. A severity score in 27 normals was 102±5 (mean ±sd) with all values >85. The severity score correlated with hepatic fibrosis (r=−0.694;P<0.001) in 109 patients with benign liver disease who had recent biopsies and with the Child-Pugh classification (r=0.78;P<0.001) in 220 patients with CLD. Furthermore, 68/70 (97%) of patients with ascites, variceal bleeding, or death from hepatic failure had a severity score <85, and all patients with severity score <60 had one of these complications. All patients with liver failure had a severity score <60 and 67.7% with a score <40 died of hepatic failure. By contrast, 99.4% of patients with minimal liver disease had a severity score >80 and 96.5% a severity score >85. Mortality, the frequency of complications of CLD, and the degree of hepatic fibrosis were inversely related to the severity score. Thus, the data support the value of the LSS in detecting the perfused Kupffer cell mass and the potential for use of the LSS as a quantitative test of hepatic function.
Similar content being viewed by others
References
Hoefs JC, Green G, Reynolds TB, Sakimura I: Mechanism for the abnormal liver scan in acute alcoholic liver injury. Am J Gastroenterol 79(12):950–958, 1984
Triger DR, Bialas C, Segasby CA, Underwood JCE: Hepatic reticulo-endothelial function. A correlation of radioisotopic and immunohistochemical assessment. Liver 9:86–92, 1989
Horisawa M, Goldstein G, Waxman A, Reynolds T: The abnormal hepatic scan of chronic liver disease: Its relationship to hepatic hemodynamics and colloid extraction. Gastroenterology 71:210–213, 1976
Triger DR, Boyer TD, Redeker AG, Reynolds TB, Waxman AD: Differences in intra-hepatic portal-systemic shunting in alcoholic and nonalcoholic liver disease as assessed by liver scan, portal pressure, and E. coli antibodies. Dig Dis Sci 24:509–513, 1980
Hoefs JC, Chang K, Wang F, Kanel G, Morgan T, Braunstein P: The quantitative liver-spleen scan is the most accurate liver test for CLD. Gastroenterology 102:22, 1992
Hoefs JC, Aufrichtig D, Lottenberg S, Kanel GC, Donner BS, Ferrari LA, Leeman S, Freidenberg RM: A non-invasive evaluation of hepatic fibrosis using frequency demodulation of ultrasound signals. Dig Dis Sci 31:1046–1055, 1986
Baudouin SV, Grey H, Hall-Craggs M, Wells CP, Rake MO, Coakley AJ: Liver scintiscanning as a screening test in the detection of alcoholic cirrhosis. Nucl Med Commun 7:71–75, 1986
Biello DR, Levitt RG, Siegel BA, Sagal SS, Stanley RJ: Computed tomography and radionuclide imaging of the liver: A comparative evaluation. Radiology 127:159–163, 1978
Drum DE, Beard JO: Liver scintigraphic features associated with alcoholism. J Nucl Med 19:154–160, 1978
Geslien GE, Pinsky Sm, Poth RK, Johnson MC: The sensitivity and specificity of99Tc-sulfur colloid liver imaging in diffuse hepatocellular disease. Radiology 118:115–119, 1976
Meek Dr, Mills PR, Gray HW, Duncan JG, Russell RI, Mckillop JH: A comparison of computed tomography, ultrasound and scintigraphy in the diagnosis of alcoholic liver disease. Br J Radiol 57:23–27, 1984
Jago JR, Gibson CJ, Diffey BL: Evaluation of subjective assessment of liver function from radionuclide images. Br J Radiol 60:127–132, 1987
Delcourt E, Vanhaeverbeek M, Binon J-P, Brasseur P, Calay R, Baudoux M, Gregoir C. Emission tomography for assessment of diffuse alcoholic liver disease. J Nucl Med 33:1337–1345, 1992
Wasnich R, Glober G, Hayashi T, Vicher T, Yeh F: Simple computer quantitation of spleen to liver ratios in the diagnosis of hepatocellular disease. J Nucl Med 20:149–154, 1979
Houston AS, Macleod MA: Processing of liver dynamic studies with technetium-labeled sulphur colloid. Br J Radiol 53:87–92, 1980
Biersack HJ, Reichmann K, Reske SN, Knopp R, Winkler C: Improvement of scintigraphic liver imaging by SPECT—a review of 797 cases. J Nucl Med 4:282–289, 1983
Grime JS, Critchley M, Roberts M, Morris AI: Single photon emission tomography (SPECT) in the evaluation of chronic liver disease. Nucl Med Commun 4:282–289, 1983
Alstead EM, Grime JS, Critchley M, Morris AI, Gilmore IT, Ware J: Is SPECT of the spleen worthwhile in the evaluation of liver disease severity? Nucl Med Commun 8:33–43, 1987
Kodama T, Watanabe K, Hoshi H, Jinnouchi S, Arakawa K, Kusumoto S, Honda H: Diagnosis of diffuse hepatocellular diseases using SPECT. J Nucl Med 27:616–619, 1986
Popper H, Elias H, Petty DE: Vascular pattern of the cirrhotic liver. Am J Clin Pathol 22:717–729, 1952
Mitra SK: Hepatic vascular changes in human and experimental cirrhosis. J Pathol Bacteriol 92:405–414, 1966
Hoefs J, Reynolds TB, Pare P, Sakimura I: A new method for the measurement of intrahepatic shunts. J Lab Clin Med 103:446–461, 1984
Huet PM, Goresky CA, Villeneuve JP: Assessment of liver microcirculation in human cirrhosis. J Clin Invest 70:1234–1244, 1982
Losowsky MS: Needle biopsy of the liver: A review. J R Soc Med 75:736–741, 1982
Wagoner GP, Ulevitch H, Gall EA, Schiff L: Biopsy needle specimens of liver tissue. Am J Clin Pathol 21:338–341, 1951
Soloway RD, Baggenstoss AH, Schoenfield LJ, Summerskill WHJ: Observer error and sampling variability tested in evaluation of hepatitis and cirrhosis by liver biopsy. Am J Dig Dis 16:1082–1086, 1971
Baunsgaard P, Sanchez GC, Lundborg CJ: The variation of pathological changes in the liver evaluated by double biopsies. Acta Pathol Microbiol Scand (A) 87:51–57, 1979
Waldstein SS: Accuracy of sampling by needle biopsy in diffuse liver disease. Arch Pathol 50:326–328, 1950
Billing BH, Conlon HJ, Hein DE, Schiff L (with technical assistance from Starr C, McGreevy E): The value of needle biopsy in the chemical estimation of liver lipids in man. J Clin Invest 32:214–225, 1953
Braunstein H: Needle biopsy of the liver in cirrhosis: Diagnostic efficiency as determined by postmortem sampling. Arch Pathol 62:87–95, 1956
Abdi W, Millan JC, Mezey E: Sampling variability on percutaneous liver biopsy. Arch Intern Med 139:667–669, 1979
Nord HJ: Biopsy diagnosis of cirrhosis: Blind percutaneous versus guided direct vision techniques—a review. Gastrointest Endosc 28:102–105, 1982
Pagliaro L, Rinaldi F, Craxi A, DiPiazza S, Filippazzo G, Gatto G, Genova G, Magrin S, Maringhini A, Orisini S, Pallazzo U, Spinello M, Vinci M: Percutaneous blind biopsy versus laparoscopy with guided biopsy in diagnosis of cirrhosis: A prospective randomized trial. Dig Dis Sci 28:39–43, 1983
Picciotto A, Ciravegna G, Lapertosa G, Celle G: Percutaneous or laparoscopic needle biopsy in the evaluation of chronic liver disease. Am J Gastroenterol 7:567–568, 1984
Galizzi J, Long RG, Billing BH, Sherlock S: Assessment of the C-14 aminopyrine breath test in liver disease. Gut 19:40–45, 1978
Taylor KJW, Gorelick FS, Rosenfield AT, Riely CA: Ultrasonography of alcoholic liver disease with histological correlation. Radiology 141:157–161, 1981
Saverymutti SH, Joseph AEA, Maxwell JD: Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J 292:13–15, 1986
Celle G, Savarino V, Picciotto A, Magnolia MR, Scalabrini P, Dodero M: Is hepatic ultrasonography a valid alternative tool to liver biopsy? Report on 507 cases studied with both techniques. Dig Dis Sci 33:467–471, 1988
Carlisle R, Galambos JR, Warren WD, et al: The relationship between conventional liver tests, quantitative function tests, and histopathology in cirrhosis. Dig Dis Sci 24:358–362, 1979
Schneider JF, Baker AL, Haines NW, Hatfield G, Boyer JL: AminopyrineN-demethylation: A prognostic test of liver function in patients with alcoholic liver disease. Gastroenterology 79:1145–1150, 1980
Scherer U, Bull U, Rothe R, Eisenburg J, Schildberg FW, Meister P, Lissner J: Computerized tomography and nuclear imaging of the liver. A comparative study in 83 cases. Dur J Nucl Med 3:71–80, 1978
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hoefs, J., Chang, K., Wang, F. et al. Perfused Kupffer cell mass. Digest Dis Sci 40, 552–560 (1995). https://doi.org/10.1007/BF02064368
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02064368