Quantitative liver imaging using '3'I Rose Bengal as an index of liver function and prognosis

SUMMARY A technique for assessing quantitatively hepatic function by direct measurement of liver parenchymal cell uptake of 131I Rose Bengal using a scintillation camera with a digital store and retrieval system is described. Ninety-four studies were performed on 84 patients with a variety of hepatic disorders over a two-year period, the diagnosis in each case being established by liver biopsy or laparotomy. The results were compared with the clinical, biochemical and histological assessment ofthe patients. A good correlation was found between the half-time for hepatic uptake of 1311 Rose Bengal and the histological changes, as well as with clinical prognosis measured in terms of clinical improvement or deterioration to death. The rate of liver uptake was found to be a better index than the clearance of radioisotope from the blood and was superior to conventional biochemical investigations in both icteric and anicteric patients. The test was not shown to be of clinical value in discriminating between intra- and extrahepatic causes of jaundice. It is suggested that this technique may provide a safe and sensitive method for assessing the severity of liver dysfunction and also for monitoring clinical progress, especially in situations where liver biopsy may be unreliable or hazardous. There is no reliable method for evaluating hepatic function and assessing the prognosis of patients with liver disease (Tygstrup, 1973). Conventional measurements such as serum albumin and prothrom-bin are non-specific and insensitive (Schiff, 1969) and liver clearance of bromsulphalein (BSP) from the circulation, whilst sensitive for relatively minor hepatic damage (Mateer, Baltz, and Marion, 1943), is unreliable in advanced disease, particularly for jaundiced patients (Mendenhall and Leevy, 1961