GEPATOGRAFIYA (Greek hepar, hepat[os] a liver + grapho to write, represent) — a X-ray or radio isotope inspection of a liver against the background of artificial contrasting of its smallest vessels or a parenchyma.
X-ray inspection of a liver is carried out: 1) by introduction to blood of hepatotropic organic compounds of iodine; 2) by an intravenous injection of a contrast agent (gepatoliyenografiya); 3) by injection in a portal blood stream of oil contrast agents (angiogepatografiya); 4) by administration of contrast medium in a parenchyma of a liver by means of a puncture of an abdominal wall.
Increase in intensity of a shadow of a liver at the first way G. is caused by property of its epithelial cells to absorb a number of X-ray contrast organic compounds of iodine. However strengthening of a shadow of a liver at the same time is insignificant. For registration and studying of this effect it is necessary to compare the same sites of a shadow of a liver to and in various terms after administration of drug.
Intravenous administration of a contrast agent — a thorotrast, yodozol I, tin oxides or suspensions of tetraiodphenolphthalein allow to receive accurate shadows of a liver and spleen (fig. 1) on the roentgenogram, to estimate situation, a form and size of these bodies, to establish their relation to the tumor palpated in a stomach, to reveal a rupture of a liver or spleen, to find the centers of defeat (tumors, cysts, abscesses). However the contrast agents used for this purpose are harmful to an organism therefore they should not be applied.
At an angiogepatografiya single introduction of 9 — 12 ml of a contrast agent (like an etiodol, ultraliquid lipiodolum and its analogs) in a spleen or an umbilical vein gives the chance to observe during 24 — 30 hours the image of small branches of a portal vein in a liver and throughout 3 weeks — almost homogeneous shadow of a parenchyma (gepatogramma) thanks to a delay of a contrast agent in sinusoids. However in connection with increase in diagnostic value scannings (see), for a gammastsintigrafiya and the selection abdominal arteriography the method of an angiogepatografiya did not find broad application.
Administration of triyodirovanny contrast medium in thickness of a liver by means of a puncture of an abdominal wall allows to investigate a local blood stream at damages of a liver and to establish localization of blockade at portal hypertensia, jaundice, fibrinferment and a prelum of hepatic veins (Badd's syndrome — Kiari). Determine the speed and outflow tracts of a contrast agent from depot in a liver by a series of roentgenograms. In the absence of pathological changes a contrast agent equally often comes to branches of portal and hepatic veins; less often on roentgenograms narrow arteries and not changed bilious channels are displayed. At pathological processes unusual communications between branches of portal and hepatic veins are defined and the vessels going to portal fissures and a hepatoduodenal sheaf come to light limf.
Diagnostic value of this technique finally is not defined.
Radio isotope gepatografiya (synonym: the gepatoradiografiya, a radiogepatografiya) is based on ability of a liver to selective accumulation of radioactive drugs and their allocation with bile. Apply to a research of function of a liver bromsulfalein or Bengalese pink, marked 131 I, and colloidal solutions of radioactive gold — 198 Au. These substances are applied in indicator quantities and therefore do not exert an adverse effect on a human body.
For assessment of function of hepatocytes use bromsulfalein or the Bengalese pink. For the purpose of blockade of a thyroid gland within 3 days to the patient appoint solution of Lugol. Then on an empty stomach administer in a vein the radioactive drug in a dose 0,3 mkkyuri/kg. The research is conducted by means of the three-channel radio count. One sensor is installed over a sigmoid venous sine, another — over the right hepatic lobe, far away from a gall bladder, and the third — on the left half of a stomach. The first sensor registers the speed of decrease in radioactivity of blood; the second — a radiation intensity — the total size reflecting absorption of radioactive material hepatocytes and its removal with bile; the third — intake of drug in intestines. Assessment of function of a liver can be made on the speed and percent of absorption of radioactive material at the beginning of the research or on the relation of size of accumulation and allocation to the maximum size in certain time terms, and also in a form of the curve its radioactivity (fig. 2): the first 5 min. after an injection of radioactive material the curve abruptly rises (an indicator of a condition of a vascular bed of a liver), in the next 20 min. rate of accumulation of substance decreases (dye is absorbed by polygonal cells of a liver), and the radiation intensity reaches a maximum which remains on a fixed level (plateau) approximately within 30 min.; then the curve decreases. The elimination half-life of dye normal makes from 80 to 100 min. This technique can be added with determination of clearance of blood and measurements of a radiation intensity over intestines. The period of semi-clarification of blood normal makes 10 — 15 min. Intake of radioactive material in intestines is noted not later than in 30 min. after an injection; after meal it sharply amplifies.
Radio isotope G.'s lack using a bromsulfalein or the Bengalese pink — impossibility of separate quantitative assessment of activity of hepatocytes and speed of removal of radioactive material since the condition of a hepatic blood-groove and a reversed current of dye in a blood plasma is not considered.
The research of function of reticuloendothelial system of a liver is conducted by administration of radioactive gold. The first and second sensors of the radio count establish as well as at a research of function of hepatocytes, the third have over a spleen. Colloid particles are absorbed by reticuloendothelial system of a liver, spleen and marrow. In a liver more than 90% of drug are late. The period of semi-clarification of blood is equal to 3,2 min. The maximum of accumulation of drugs in a liver is observed in 10 min. after an injection. Are usually limited to single measurement of a radiation intensity over a liver and a spleen in 20 min. after an injection. Absorption is normal 198 Au in a liver in 15 times more, than in a spleen.
This method as well as previous, it is not deprived of a shortcoming: the clearance of blood from 198Au is not direct reflection of a hepatic blood-groove. In this regard the complex research of kinetics of colloid particles with the simultaneous accounting of clearance of blood and share of a liver in this process by means of radiometry of all body during the shielding is of interest lead of area of a liver.
The clinic uses the combined techniques more often — consecutive use of two marked connections (a bromsulfaleina or Bengalese pink and 198 Au), allowing to obtain not only general information about kinetics of marked connections in an organism, but also the differentiated data on a hepatic blood-groove, activity of hepatocytes and speed of removal of radioactive material with bile, or radio isotope G.'s combination with stsintigrafiya (see). In the latter case after introduction to a vein 250 mkk the Bengalese pink make a series skanogramm a liver, using the high-speed scanner, or a series stsintifotogramm on the gamma camera. Measure intensity of gamma radiation over a liver in intervals. Comparison of the obtained data is especially valuable to differential diagnosis of hepatic and obturatsionny jaundice.
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L. D. Lindenbraten.