Acta Radiológica 33 (1992) Fase. 5 FROM THE DEPARTMENT OF DIAGNOSTIC RADIOLOGY, ST. GORAN'S HOSPITAL, STOCKHOLM, SWEDEN.
BONE MARROW EXTENSION AND PELVIC BONE MARROW ACTIVITY IN ALCOHOLIC LIVER DISEASE A RES scintigraphic investigation U. RUDBERG
Abstract Red bone marrow extension and increased central bone marrow activity were found in 21 patients with alcoholic liver disease investi gated with scintigraphy of the reticuloendothelial system. The pa tients had no concurrent disease known to alter red bone marrow distribution. The bone marrow extension and the increased pelvic bone marrow activity may be explained as being secondary to a decreased radiocolloid uptake in the liver and could thus be a sign of decreased reticuloendothelial capacity. Key words: Liver, cirrhosis; radionuclide studies; bone marrow, radionuclide studies; reticuloendothelial system. Scintigraphy of the reticuloendothelial system (RES) is a sensitive method for the detection of alcoholic liver disease (7, 13, 21, 23). To further enhance the usefulness of the method, it is necessary to register not only uptake pathology in the liver, but also other parameters (17). The decreased liver uptake of radiocolloids seen in patients with alcoholic liver disease gives a secondary increase of uptake in the spleen and bone marrow (8, 10, 19, 34). A spleen-to-liver uptake ratio may thus be used as an indicator of the degree of liver damage (11, 33, 35). The increased central bone marrow uptake has been assessed semiquantitatively from a posterior recording of pelvic bone marrow activity at preset time (10). Another RES scintigraphic finding in alco holic liver disease, but sparsely discussed in the literature, is red bone marrow extension. ALTMEYER et al. (2) reported on bone marrow extension in 3 psoriatics with cirrhosis of the liver. RUDBERG et al. (30), studying bone marrow exten sion in prostatic carcinoma, described 2 patients with marked extension and coexisting alcoholic liver disease. The purpose of the present investigation was to study pelvic bone marrow activity and the occurrence and degree of red bone marrow extension in patients with alcoholic liver
disease, excluding patients with other disease known to alter red bone marrow distribution.
Material and Methods The material consisted of patients with alcoholic liver disease studied with RES scintigraphy. The studies were performed between December 1989 and November 1991. For inclusion in this investigation, patients had to be free of any concurrent disease known to alter red bone marrow distribution, i.e., chronic anemia, hématologie disease or malignancy. Twenty-one patients fulfilled these criteria; 8 women with a mean age of 57 years (range 36-87 years) and 13 men with a mean age of 59 years (range 41-74 years). The diagnoses, i.e., alcohol-induced liver disease, such as cirrhosis, steatosis and alcoholic hepatitis, were based on clinical and radiological findings, laboratory tests, endoscopy and the RES scintigraphy. In 8 patients the diagnoses were confirmed by biopsy or autopsy. Sixteen of the 21 patients had esophageal varices and/or ascites. The RES scintigraphy started with visceral radiocolloid angiography where the radiopharmaceutical was given as a bolus injection in an antecubital vein (9). Sixteen frames of 3 s duration were collected followed by 8 frames of 6 s duration. The angiographie images were interpreted from hard copies and after generation of time-activity curves. A generalized increase of the arterial blood flow to the liver was considered to exist if the early part of the hepatic timeactivity curve was steep and coincided with the arterial rise of the spleen and left kidney time-activity curves (29). Multiple static images of the liver and spleen were recorded Accepted for publication 21 January 1992.
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Downloaded from acr.sagepub.com at UNIV OF MICHIGAN on June 20, 2015
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RES IN ALCOHOLIC DISEASE
Table RES scintigraphic findings in 21 patients with alcoholic liver disease Pat/Age/Sex
BME (grade)
1/41/M 2/72/M 3/45/M 4/47/M 5/54/F 6/65/M 7/87/F 8/36/F 9/39/F 10/65/M 11/44/F 12/58/F 13/67/F 14/57/M 15/70/F 16/62/M 17/70/M 18/45/M 19/56/M 20/74/M 21/72/M
II III III III III III III III III III III III III III III III III III III III III
tib tib tib tib tib tib tib tib tib
BMA
Liver flow
S/L
Splenomegaly
PU
155 167 178 228 241 256 267 276 337 414 431 522 195 198 238 260 264 269 349 414 514
-
2.0 1.0 1.0 1.5 2.0 2.0 2.0 4.0 5.0 2.5 2.0 6.0 3.5 1.5 4.0 5.5 1.5 6.0 2.0 1.5 5.0
+ + + + + + + + + + + + + + + + +
_ + + + + + + + +
art
art art art art
art art art art art art art art
art
BME bone marrow extension in femur: II—third fourth; Ill-last fourth; and III tib-whole femur and tibia. BMA - pelvic bone marrow activity in kcnt/180 s. art generalized increase of arterial blood flow. S/L - spleen-liver ratio. PU - pulmonary uptake.
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BONE MARROW EXTENSION AND PELVIC BONE MARROW ACTIVITY IN ALCOHOLIC LIVER DISEASE A RES scintigraphic investigation U. RUDBERG
Abstract Red bone marrow extension and increased central bone marrow activity were found in 21 patients with alcoholic liver disease investi gated with scintigraphy of the reticuloendothelial system. The pa tients had no concurrent disease known to alter red bone marrow distribution. The bone marrow extension and the increased pelvic bone marrow activity may be explained as being secondary to a decreased radiocolloid uptake in the liver and could thus be a sign of decreased reticuloendothelial capacity. Key words: Liver, cirrhosis; radionuclide studies; bone marrow, radionuclide studies; reticuloendothelial system. Scintigraphy of the reticuloendothelial system (RES) is a sensitive method for the detection of alcoholic liver disease (7, 13, 21, 23). To further enhance the usefulness of the method, it is necessary to register not only uptake pathology in the liver, but also other parameters (17). The decreased liver uptake of radiocolloids seen in patients with alcoholic liver disease gives a secondary increase of uptake in the spleen and bone marrow (8, 10, 19, 34). A spleen-to-liver uptake ratio may thus be used as an indicator of the degree of liver damage (11, 33, 35). The increased central bone marrow uptake has been assessed semiquantitatively from a posterior recording of pelvic bone marrow activity at preset time (10). Another RES scintigraphic finding in alco holic liver disease, but sparsely discussed in the literature, is red bone marrow extension. ALTMEYER et al. (2) reported on bone marrow extension in 3 psoriatics with cirrhosis of the liver. RUDBERG et al. (30), studying bone marrow exten sion in prostatic carcinoma, described 2 patients with marked extension and coexisting alcoholic liver disease. The purpose of the present investigation was to study pelvic bone marrow activity and the occurrence and degree of red bone marrow extension in patients with alcoholic liver
disease, excluding patients with other disease known to alter red bone marrow distribution.
Material and Methods The material consisted of patients with alcoholic liver disease studied with RES scintigraphy. The studies were performed between December 1989 and November 1991. For inclusion in this investigation, patients had to be free of any concurrent disease known to alter red bone marrow distribution, i.e., chronic anemia, hématologie disease or malignancy. Twenty-one patients fulfilled these criteria; 8 women with a mean age of 57 years (range 36-87 years) and 13 men with a mean age of 59 years (range 41-74 years). The diagnoses, i.e., alcohol-induced liver disease, such as cirrhosis, steatosis and alcoholic hepatitis, were based on clinical and radiological findings, laboratory tests, endoscopy and the RES scintigraphy. In 8 patients the diagnoses were confirmed by biopsy or autopsy. Sixteen of the 21 patients had esophageal varices and/or ascites. The RES scintigraphy started with visceral radiocolloid angiography where the radiopharmaceutical was given as a bolus injection in an antecubital vein (9). Sixteen frames of 3 s duration were collected followed by 8 frames of 6 s duration. The angiographie images were interpreted from hard copies and after generation of time-activity curves. A generalized increase of the arterial blood flow to the liver was considered to exist if the early part of the hepatic timeactivity curve was steep and coincided with the arterial rise of the spleen and left kidney time-activity curves (29). Multiple static images of the liver and spleen were recorded Accepted for publication 21 January 1992.
464
Downloaded from acr.sagepub.com at UNIV OF MICHIGAN on June 20, 2015
465
RES IN ALCOHOLIC DISEASE
Table RES scintigraphic findings in 21 patients with alcoholic liver disease Pat/Age/Sex
BME (grade)
1/41/M 2/72/M 3/45/M 4/47/M 5/54/F 6/65/M 7/87/F 8/36/F 9/39/F 10/65/M 11/44/F 12/58/F 13/67/F 14/57/M 15/70/F 16/62/M 17/70/M 18/45/M 19/56/M 20/74/M 21/72/M
II III III III III III III III III III III III III III III III III III III III III
tib tib tib tib tib tib tib tib tib
BMA
Liver flow
S/L
Splenomegaly
PU
155 167 178 228 241 256 267 276 337 414 431 522 195 198 238 260 264 269 349 414 514
-
2.0 1.0 1.0 1.5 2.0 2.0 2.0 4.0 5.0 2.5 2.0 6.0 3.5 1.5 4.0 5.5 1.5 6.0 2.0 1.5 5.0
+ + + + + + + + + + + + + + + + +
_ + + + + + + + +
art
art art art art
art art art art art art art art
art
BME bone marrow extension in femur: II—third fourth; Ill-last fourth; and III tib-whole femur and tibia. BMA - pelvic bone marrow activity in kcnt/180 s. art generalized increase of arterial blood flow. S/L - spleen-liver ratio. PU - pulmonary uptake.
&
