Transportal Technetium-99m Labeled Macroaggregated Albumin Scintigraphy to Quantify Occult Intrahepatic Microvascular Portosystemic Shunting

Cynthia De la Garza-Ramos, Mohamed S. Muneer, Jason T. Lewis, Denise M. Harnois, C. Burcin Taner, Gregory T. Frey, Barry Rosser, Beau B. Toskich

Research output: Contribution to journalArticlepeer-review

Abstract

Nodular regenerative hyperplasia (NRH) of the liver may lead to noncirrhotic portal hypertension with subsequent development of portosystemic shunts. While extrahepatic and macrovascular shunts are readily visualized with imaging or endoscopy, there is no standard technique to detect intrahepatic microvascular portosystemic shunting and quantitatively assess shunt burden. We present a case of a 53-year-old female with suspected NRH and hepatopulmonary syndrome with inconclusive liver biopsies and absent portosystemic shunts per abdominal imaging. A percutaneous transportal infusion of Technetium-99m labeled macroaggregated albumin (99mTc-MAA) successfully identified intrahepatic microvascular portosystemic shunting and quantified a lung shunt fraction of more than 30%. NRH was subsequently confirmed with a surgical wedge biopsy and the patient was successfuly treated with a liver transplant. Transportal 99mTc-MAA could be used to both identify and quantify otherwise occult microvascular portosystemic shunts in patients with clinical sequelae of portal hypertension.

Original languageEnglish (US)
Pages (from-to)975-978
Number of pages4
JournalRadiology Case Reports
Volume16
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • 99mTc-MAA
  • liver transplantation
  • nodular regenerative hyperplasia
  • portal hypertension
  • portosystemic shunting

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Fingerprint Dive into the research topics of 'Transportal Technetium-99m Labeled Macroaggregated Albumin Scintigraphy to Quantify Occult Intrahepatic Microvascular Portosystemic Shunting'. Together they form a unique fingerprint.

Cite this