The extrahepatic uptake of198Au as an index of portal hypertension

A study was undertaken to determine if extrahepatic recticuloendothelial uptake of¹⁹⁸Au during hepatic scanning could be used as a measure of the portal venous pressure in patients with chronic diffuse liver disease. Twenty patients were studied by history, physical examination, liver function studies, liver biopsy, esophagoscopy,¹⁹⁸Au hepatic scan and wedged hepatic vein pressure measurements. Patients were separated into 2 groups: Group A—patients with neither spleen or lumbar vertebral bone marrow uptake of¹⁹⁸Au; Group B—patients with significant spleen and/or vertebral bone marrow uptake of isotope. Each of the 6 patients in Group A had a hepatic wedge pressure under 18 mmHg, and none had varices on esophagoscopy. All 14 patients in Group B had hepatic wedge pressures of 18 mmHg or more. Only 8 Group B patients had varices on esophagoscopy. These data suggest that the¹⁹⁸Au hepatic scan is a safe and valuable procedure for estimating the degree of portal venous hypertension in patients with diffuse chronic liver disease. In these 20 patients, if spleen or vertebral bone marrow uptake of isotope was present, the portal venous pressure was 18 mmHg or greater. If spleen and/or bone marrow uptake was lacking, then the portal venous pressure was below 18 mmHg.