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P-255 Spatiotemporal measurement of free radical elimination in the abdomen using an in vivo electron spin resonance imaging system
SI00
Posters/International Hepatoiogy Communications 3 Suppl. (1995) $37-S169
P-253
RENAL HEMODYNAMICS IN CIRRHOSIS EVALUATED BY VELOCITY WAVE FORM ANALYSIS USING DUPLEX DOPPLER ULTRASONOGRAPHY M.Koda*, S.lkawa*, K.Okada2., HKawasaki2. *: Dept. of Clinical Laboratory Medicine, 2.: 2nd Dept. of Medicine, Faculty of Medicine, Tottori Univ, Yonago 683, Japan Functional renal failure in liver cirrhosis is considered a consequence of active renal vasoconstriction. Duplex Doppler can be used as a new method for non invasive evaluation of vascular resistance in the small renal vessels. This study analyzed velocity wave forms in different stages in chronic liver diseases and evaluated the relationship between renal vascular resistance and vasoactive hormones. Subjects and methods Subjects consisted of 7 healthy controls, 10 patients with chronic inactive hepatitis, 37 patients with chronic active hepatitis and 88 patients with liver cirrhosis We idemified the renal intralobar artery and obtained velocity wave forms by pulse Doppler system. The pulsatility index (PI) and the resistive index (RI) were calculated according to the following formulas : Pl=(Vmax - Vmin)/Vmean, Rl=(Vmax - Vmin)/Vmax Each result was the mean of five measurements in different areas. Results Both PI and RI were significantly higher in cirrhotic patients than in healthy controls, CIH patients or CAH patients (Pl. 1.13 vs 0 87, 0 90, 0.96, RI : 0 65 vs 0.54, 0.57, 0 59, respectively) In cirrhotic patients, PI increased with the Child-Pugh grade PI and RI were significantly higher in ascitic patients than in nonascitic patients (PI " I 38 vs 1.07, RI 0 71 vs 0.64). There was a significant inverse correlation between PI or RI and serum albumin and a significant correlation between PI or RI and the [CG retention rate at 15 rain A significant correlation was found between PI or RI and plasma renin activity, between P1 or RI and plasma aldosterone level and between Pl or RI and atrial natriuretic pepfide. Conclusion Pl and RI were increased in cirrhotic patients, and were particularly greater in ascitic patients. Alteration of renal arterial resistance indices was shown to be related to vasoactive hormones This noninvasive method may be applied to the assessment of renal impairment in cirrhosis.
P-255
SPATIOTEMPORAL MEASUREMENT OF F R E E R A D I C A L E L I M I N A T I O N IN T H E A B D O M E N U S I N G A N I N VIVO E L E C T R O N S P I N R E S O N A N C E IMAGING SYSTEM H. Togashi, H, Shinzawa, Y. Huang, S. Oimo, Y. Salo, T. Koseki, K. Suzuki, E. Yoshii, T. Matanhashi, I. Aoyama, M. Kuboki, M. lshibashi, H. Wakabayashi, T. Takahashi, T. Ogala*. 2nd Dept. of Internal Medicine, Yamagata Univ. School of Medicine. * Faculty of Engineering, Yamagata Univ. Electron spin resonance (ESR) imaging can visualize the distribution of free radicals in living systems according to their concentrations. In contrast to magnetic resonance imaging (MRI), which relies on the NMR signal of protons of water molecules, application of ESR imaging to living animals has not well been established. Using a rapid field scan L-band ESR imaging system we have successfully obtained spatiotemporal images of the abdomen of living mice after injection of 3-carbamoyl-2,2,5,5-tetramethylpyrroliny1-oxy (CPROXYL) from the tail vein. Among the organs of the body, CPROXYL was distributed most prominently in the liver. Twodimensional ESR imaging demonslrated the decay behavior of CPROXYL that had aecumulated in the liver. The disappearunce of CPROXYL began from the liver hilus, and then gradually extended to the peripheral region. At 5 rain after CPROXYL administration, CPROXYL in the liver nearly disappeared. In liver that lind been damaged by carbon tetrachlodde, the decay of CPROXYL was markedly prolonged. At 5 min after CPROXYL administration, CPROXYL remained clearly in the peripheral region of the liver. In vivo threedimensional ESR images showed an even distribution of CPROXYL throughout the whole liver and the image corresponded well with transaxial seclions of the mouse abdomen. We succeeded for the first time in displaying clear images of flee radical distribution and clearance in the organs of a living animal. This technique is considered to be a powerful new tool for the in vivo analysis of pathophysiologic states using spatiotvmporal differences in CPROXYL elimination.
P-254
LOSS OF PHASIC OSCILLATIONS IN DOPPLER WAVEFORM OF HEPATIC VEINS IN PATIENTS WITH VIRAL CIRRHOSIS H. Kawanaka, M. Hashizume, M. Ohta, F. Kishihara, H. Higashi, M. Tomikawa, K. Sugimachi Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
To examine the clinical significance of loss of phasic oscillations in Doppler waveform of hepatic veins (HVs) in 72 patients with viral cirrhosis, we classified the Doppler waveform into four types, and compared the type to clinical data, including type IV collagen, a marker of liver fibrosis and to portal hemodynamics. Type I was a triphasic waveform, type II a biphasic waveform without reversed flow, type III decreased amplitude of phasic oscillations, and type IV a fiat waveform. Type I was found in 23 (31.9%), type II in 27 (37.5%), type III in 18 (25.0%), type IV in 4 (5.6%). Significantly direct correlations were observed between types of HV waveform and Child-Pugh score, serum type IV collagen level, or portal perfusion per liver volume (LV). A significantly inverse correlation was observed between types of HV waveform and portal vascular resistance. We also used pulsatility index (PI) [PI = (maximum velocity - minimum velocity)/mean velocity] to quantify the HV waveform. The number of types increased, PI decreased. PI significantly correlated with Child-Pugh score (r= - 0.26, p < 0.05), serum type IV collagen level (r= - 0.412, p < 0.01), portal perfusion per LV (r=- - 0A38, p < 0.001), and portal vascular resistance (r=- 0.624, p < 0.001). These data suggest that mechanisms of changes in HVs may be related both to the degree of liver fibrosis and to the increase of portal perfusion per LV and the reduction of portal vascular resistance. These changes in HVs could occur in the presence of the diffuse alteration in the liver parenchyma due to fibrogenesis and to the development of an intrahepatic shunt. Patterns of HV waveform might serve as an useful index to estimate the extent of viral cirrhosis.
P-256
QUANTITATIVE EVALUATION OF HEPATIC RESERVE WITH 99 mTe-DTPA-GALACTOSYL-HUMAN S E R U M ALBUMIN Chizu Komeda 1), Sang Kil Ha-kawa2), Masahiro Satol), Jiro TateiwaI), Takuno Miznno1), Kyoichi Inoue I ) and Yoshimasa Tunaka2), 1)The 3rd Dept. of Internal Medicine and 2)Dept. of Radiology, Kansai Medical Univ., Moriguchi, Osaka, Japan Objective: Since galactosyl-humun serum albumin (GSA) accumulates in the liver perenchymal cells via receptors, hepatic sclntigraphy using 99mTcDTPA-GSA allows us to obtain images of the liver and to evaluate liver function quantitatively. The present study was undertaken to examine how the features revealed by GSA liver scintigmphy would be reflected in the findings yielded by the indocyunine green (ICG) test, biochemical test and histopathological examination. Methods: The study included 144 cases with chronic hver disease. Histological examination was also carried out on 31 cases. The ICG test was employed to determrae its ICGRI5. The grades of GSA accumulation (imaging grades) were rated as follows: Grade 1 (unclear cardiac pool), Grade 2 (clear cardiac pool but less marked than the liver shadow), Grade 3 (similarly marked cardiac pool and liver shadow) and Grade 4 (cardiac pool more marked than liver shadow). The histological activity index(HAI) scoring system by Knodell et al, was used for histo]og3cal examination. Background variables examined included PT, hepaplastin, total bilirubin, albumin, hyaluronic acid, PIIIP, and type IV collagen. Results: The imaging grades correlated well with the ICG test results. Thus, the ICG value became less favorable as the grades became more severe. Both GSA and ICG corre]ated well with the background variables. The ratio of chronic hepatitis cases to liver cirrhosis cases differed significantly in different imaging grades. HAI scores correlated well with imaging grades, while the correlation between HAl scores and ICG was lower. C o n c l u s i o n : These results suggest that hepatic scintigraphy receptor imaging using GSA, can detect histological changes more sensitively than ICG, and that it allows simple measurement of the absolute number of functioning liver cells.
Posters/International Hepatoiogy Communications 3 Suppl. (1995) $37-S169
P-253
RENAL HEMODYNAMICS IN CIRRHOSIS EVALUATED BY VELOCITY WAVE FORM ANALYSIS USING DUPLEX DOPPLER ULTRASONOGRAPHY M.Koda*, S.lkawa*, K.Okada2., HKawasaki2. *: Dept. of Clinical Laboratory Medicine, 2.: 2nd Dept. of Medicine, Faculty of Medicine, Tottori Univ, Yonago 683, Japan Functional renal failure in liver cirrhosis is considered a consequence of active renal vasoconstriction. Duplex Doppler can be used as a new method for non invasive evaluation of vascular resistance in the small renal vessels. This study analyzed velocity wave forms in different stages in chronic liver diseases and evaluated the relationship between renal vascular resistance and vasoactive hormones. Subjects and methods Subjects consisted of 7 healthy controls, 10 patients with chronic inactive hepatitis, 37 patients with chronic active hepatitis and 88 patients with liver cirrhosis We idemified the renal intralobar artery and obtained velocity wave forms by pulse Doppler system. The pulsatility index (PI) and the resistive index (RI) were calculated according to the following formulas : Pl=(Vmax - Vmin)/Vmean, Rl=(Vmax - Vmin)/Vmax Each result was the mean of five measurements in different areas. Results Both PI and RI were significantly higher in cirrhotic patients than in healthy controls, CIH patients or CAH patients (Pl. 1.13 vs 0 87, 0 90, 0.96, RI : 0 65 vs 0.54, 0.57, 0 59, respectively) In cirrhotic patients, PI increased with the Child-Pugh grade PI and RI were significantly higher in ascitic patients than in nonascitic patients (PI " I 38 vs 1.07, RI 0 71 vs 0.64). There was a significant inverse correlation between PI or RI and serum albumin and a significant correlation between PI or RI and the [CG retention rate at 15 rain A significant correlation was found between PI or RI and plasma renin activity, between P1 or RI and plasma aldosterone level and between Pl or RI and atrial natriuretic pepfide. Conclusion Pl and RI were increased in cirrhotic patients, and were particularly greater in ascitic patients. Alteration of renal arterial resistance indices was shown to be related to vasoactive hormones This noninvasive method may be applied to the assessment of renal impairment in cirrhosis.
P-255
SPATIOTEMPORAL MEASUREMENT OF F R E E R A D I C A L E L I M I N A T I O N IN T H E A B D O M E N U S I N G A N I N VIVO E L E C T R O N S P I N R E S O N A N C E IMAGING SYSTEM H. Togashi, H, Shinzawa, Y. Huang, S. Oimo, Y. Salo, T. Koseki, K. Suzuki, E. Yoshii, T. Matanhashi, I. Aoyama, M. Kuboki, M. lshibashi, H. Wakabayashi, T. Takahashi, T. Ogala*. 2nd Dept. of Internal Medicine, Yamagata Univ. School of Medicine. * Faculty of Engineering, Yamagata Univ. Electron spin resonance (ESR) imaging can visualize the distribution of free radicals in living systems according to their concentrations. In contrast to magnetic resonance imaging (MRI), which relies on the NMR signal of protons of water molecules, application of ESR imaging to living animals has not well been established. Using a rapid field scan L-band ESR imaging system we have successfully obtained spatiotemporal images of the abdomen of living mice after injection of 3-carbamoyl-2,2,5,5-tetramethylpyrroliny1-oxy (CPROXYL) from the tail vein. Among the organs of the body, CPROXYL was distributed most prominently in the liver. Twodimensional ESR imaging demonslrated the decay behavior of CPROXYL that had aecumulated in the liver. The disappearunce of CPROXYL began from the liver hilus, and then gradually extended to the peripheral region. At 5 rain after CPROXYL administration, CPROXYL in the liver nearly disappeared. In liver that lind been damaged by carbon tetrachlodde, the decay of CPROXYL was markedly prolonged. At 5 min after CPROXYL administration, CPROXYL remained clearly in the peripheral region of the liver. In vivo threedimensional ESR images showed an even distribution of CPROXYL throughout the whole liver and the image corresponded well with transaxial seclions of the mouse abdomen. We succeeded for the first time in displaying clear images of flee radical distribution and clearance in the organs of a living animal. This technique is considered to be a powerful new tool for the in vivo analysis of pathophysiologic states using spatiotvmporal differences in CPROXYL elimination.
P-254
LOSS OF PHASIC OSCILLATIONS IN DOPPLER WAVEFORM OF HEPATIC VEINS IN PATIENTS WITH VIRAL CIRRHOSIS H. Kawanaka, M. Hashizume, M. Ohta, F. Kishihara, H. Higashi, M. Tomikawa, K. Sugimachi Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
To examine the clinical significance of loss of phasic oscillations in Doppler waveform of hepatic veins (HVs) in 72 patients with viral cirrhosis, we classified the Doppler waveform into four types, and compared the type to clinical data, including type IV collagen, a marker of liver fibrosis and to portal hemodynamics. Type I was a triphasic waveform, type II a biphasic waveform without reversed flow, type III decreased amplitude of phasic oscillations, and type IV a fiat waveform. Type I was found in 23 (31.9%), type II in 27 (37.5%), type III in 18 (25.0%), type IV in 4 (5.6%). Significantly direct correlations were observed between types of HV waveform and Child-Pugh score, serum type IV collagen level, or portal perfusion per liver volume (LV). A significantly inverse correlation was observed between types of HV waveform and portal vascular resistance. We also used pulsatility index (PI) [PI = (maximum velocity - minimum velocity)/mean velocity] to quantify the HV waveform. The number of types increased, PI decreased. PI significantly correlated with Child-Pugh score (r= - 0.26, p < 0.05), serum type IV collagen level (r= - 0.412, p < 0.01), portal perfusion per LV (r=- - 0A38, p < 0.001), and portal vascular resistance (r=- 0.624, p < 0.001). These data suggest that mechanisms of changes in HVs may be related both to the degree of liver fibrosis and to the increase of portal perfusion per LV and the reduction of portal vascular resistance. These changes in HVs could occur in the presence of the diffuse alteration in the liver parenchyma due to fibrogenesis and to the development of an intrahepatic shunt. Patterns of HV waveform might serve as an useful index to estimate the extent of viral cirrhosis.
P-256
QUANTITATIVE EVALUATION OF HEPATIC RESERVE WITH 99 mTe-DTPA-GALACTOSYL-HUMAN S E R U M ALBUMIN Chizu Komeda 1), Sang Kil Ha-kawa2), Masahiro Satol), Jiro TateiwaI), Takuno Miznno1), Kyoichi Inoue I ) and Yoshimasa Tunaka2), 1)The 3rd Dept. of Internal Medicine and 2)Dept. of Radiology, Kansai Medical Univ., Moriguchi, Osaka, Japan Objective: Since galactosyl-humun serum albumin (GSA) accumulates in the liver perenchymal cells via receptors, hepatic sclntigraphy using 99mTcDTPA-GSA allows us to obtain images of the liver and to evaluate liver function quantitatively. The present study was undertaken to examine how the features revealed by GSA liver scintigmphy would be reflected in the findings yielded by the indocyunine green (ICG) test, biochemical test and histopathological examination. Methods: The study included 144 cases with chronic hver disease. Histological examination was also carried out on 31 cases. The ICG test was employed to determrae its ICGRI5. The grades of GSA accumulation (imaging grades) were rated as follows: Grade 1 (unclear cardiac pool), Grade 2 (clear cardiac pool but less marked than the liver shadow), Grade 3 (similarly marked cardiac pool and liver shadow) and Grade 4 (cardiac pool more marked than liver shadow). The histological activity index(HAI) scoring system by Knodell et al, was used for histo]og3cal examination. Background variables examined included PT, hepaplastin, total bilirubin, albumin, hyaluronic acid, PIIIP, and type IV collagen. Results: The imaging grades correlated well with the ICG test results. Thus, the ICG value became less favorable as the grades became more severe. Both GSA and ICG corre]ated well with the background variables. The ratio of chronic hepatitis cases to liver cirrhosis cases differed significantly in different imaging grades. HAI scores correlated well with imaging grades, while the correlation between HAl scores and ICG was lower. C o n c l u s i o n : These results suggest that hepatic scintigraphy receptor imaging using GSA, can detect histological changes more sensitively than ICG, and that it allows simple measurement of the absolute number of functioning liver cells.