核醫科
門朝陽醫師
A 54-year-old male with alcoholic liver
cirrhosis, who underwent Ga-67
inflammation scan, was found to have
marked two separated hepatic lobes.
Furthermore, HIDA scan and Liver scan
with SPECT shows there are small region
of adhesion between two hepatic lobes.
Past history& surgery Hx:
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liver cirrhosis child A-B ascitis and
alcoholism.
UGI bleeding history, hepatic coma
Gouty arthritis, right
EV, congestive gastropathy.s/p EVL
Anxiety disorder
Right ureteral stone
Right femur intertrochanteric fracture S/P ORIF
and DHS.
Abdominal sono(92/10/27):
 Liver cirrhosis with splenomegaly
 Mild ascitis. GB wall thickening
 Nuclear medicine studies:
 HIDA scan: r/o cholecystitis
 Ga-67 inflammation scan: infection?
 Liver scan with SPECT: study
 Enterogastric refulx study and GET.
Radiological study:
 Abdominal CT
2001-5-22; 2001-10-31;2004-3-1
comparison and shows:
CT report:
 We trace his previous CT scans found
this case has gradually caudate lobe
atrophy. This interesting finding -marked two separated hepatic lobes,
may help us to diagnosis unusual type
of caudate lobe atrophy with alcoholic
liver cirrhosis.
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Change in size, shape and radiocolloid
uptake of the alcoholic liver during alcohol
withdrawal, as demonstrated by single
photon emission computed tomography
The volume of the total liver and separate right and left lobes was studied
before and after 1 week of alcohol withdrawal in 16 consecutive
alcoholics by means of single photon emission computed tomography
after intravenous injection of 99Tcm-human albumin colloid; the relative
tissue distribution of radioactivity was also followed. The left liver lobe
increased in volume more than the right lobe during drinking and
decreased more rapidly after alcohol withdrawal. Median volume
reductions during 1 week of alcohol withdrawal w ere: total liver 12%, left
lobe 26%, and right lobe 8%, indicating that half of the reduction to values
of a control group was achieved during this first week. The volume of the
right but not of the left lobe was significantly correlated to body size in
alcoholics and in controls. The left lobe had a lower capacity to
concentrate the radiocolloid than the right lobe in alcoholics and in
controls. The liver/spleen, liver/bone marrow and liver/background
radioactivity concentration ratios in the alcoholics increased during
alcohol withdrawal. We conclude that heavy drinking causes both an
increased total liver volume and a change in liver shape, with a relatively
more enlarged left than right lobe, as well as a decreased capacity to
concentrate radiocolloid. These changes are rapidly reversible during
abstinence from alcohol.
J Hepatol. 1994 Sep;21(3):417-23. Sweden.
Couinaud Segments
Fig 1-1Anterior and posterior view of liver showing 3-dimensional
reconstructions of helical CT scan data in shaded surface projections
which have been segmented according to the Couinaud
classification (dotted line represents the course of the portal vein
which is sometimes used to to divide segment IV into segments IVa
and IVb).
Fig 1-2 Shaded-Surface 3D reconstructions of the liver segments
viewed in the transverse plane at the level of the rostral part of the
liver and inferiorly from the caudal surface.
Classification and distribution of cirrhosis
 Commen causes:
Alcoholism(western); CAH(HBV)(far east);
autoimmune(euro caucasians); primary biliary
cirrhosis(>90% F)
schistosomiasis(equatorial:fibrosis but
cirrhosis found in S. japanicum)
Rare but potential:
Wilson; drug induced; biliary atresia
hemachromastosis; constrictive pericarditis
Rare: cystic fibrosis. Scherosing cholangitis
glycogen storage disease. A1 antitrypsin def.
Pathogenesis:
 The metabolism of ethanol(alcohol) to
acetaldehyde and acetate dependent to
:
alchol dehydrogenase and
acetaldehyde dehydrogenase and need
NADH from NAD(NADPH to NADP)
 In alcoholism the MEOS is induced
 Unwanted by products: hyperuricemia,
hyperglycemia, ketosis, fatty liver.(redox
state of cell in lipid and carbohydrate
metabolism, steatosis)
Child’s classification of severity of cirrhosis
 Feture
points scored for increasing abnormalities

1
2
3
 Encephalopathy
None
1 and 3
3 and 4
 Ascitis
None
mild
mod/sev
 Plasma bilirubin
<25
25-40
(mol/l)
Plasma albumin
(g/l)
>35
28-35
>40
<28
Prothrombin time
1-4
4-6
>6
(secs prolonged)
Total score: 5-6= grade A; 7-9=grade B;10-15=grade C
Alcoholic liver cirrhosis?
 Is it typical case?(For gap formation)
 Or uncommon case of left hepatic lobe
cirrhosis in segment I( Caudate lobe
atrophy)?
Or complex to tell due to HBV infection
with ascitis and pleural effusion?
Caudate lobe atrophy?by CT
 What else could we afford to the clinicians
about liver cirrhosis case?
 What kind of study or variant do we need
to improve in liver cirrhosis case
with EV or case like this?
What do you think?