Increased Hepatic Arterial Blood Flow Measured by Hepatic Perfusion Index in Hepatosplenic Schistosomiasis: New Concepts for an Old Disease
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Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS).
This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS.
Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed.
It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p = 0.0029) and that this increase correlated with splenic length (p = 0.038) and diameter of esophageal varices (p = 0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices.
Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver “arterialization,” as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.
KeywordsHepatosplenic schistosomiasis Scintigraphy Angioscintigraphy Hepatic perfusion
Special thanks go to Socrates Times de Carvalho for mathematical assistance with regression analysis of graphical data.
Bernardo Times de Carvalho: study concept and design, data acquisition, statistical analysis, data interpretation, and manuscript writing. Ana Lúcia Coutinho Domingues: study concept and design and critical manuscript review for important intellectual concepts. Edmundo Pessoa de Almeida Lopes: critical manuscript review for important intellectual concepts. Simone Cristina Soares Brandão: study concept and design, and data acquisition.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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