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A noninvasive diagnostic approach using per-rectal portal scintigraphy for sinusoidal obstruction syndrome after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 55, pages 470–472 (2020)Cite this article

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Hepatic sinusoidal obstruction syndrome (SOS) is a potentially life-threatening complication that develops after allogeneic hematopoietic cell transplantation (allo-HCT); in severe cases, its mortality rate is reported to be higher than 80% [1, 2]. The clinical features of SOS include jaundice, weight gain, ascites, and tender hepatomegaly. Although transjugular liver biopsy is informative, due to its potentially lethal complications [1,2,3], the diagnosis is often made based on clinical criteria, i.e., Seattle or Baltimore criteria. However, it was reported that the positive predictive value (PPV) in Seattle criteria and the sensitivity in Baltimore criteria were relatively low, hence, these criteria yield unsatisfactory diagnostic accuracy [4, 5]. Early and accurate diagnosis and early interventions for SOS are the keys to improving its prognosis [1, 2]; therefore, a novel noninvasive diagnostic approach with greater accuracy is needed.

Apart from liver biopsy with its potential risk of major bleeding, the measurement of the hepatic venous pressure gradient (HVPG) representing the portal pressure has been reported to be the most accurate method for diagnosing SOS [1, 2]. Per-rectal portal scintigraphy (PRPS) is a noninvasive and safe nuclear medicine examination to estimate the portal pressure using the portal shunt index (SI), which is calculated from radioactivity curves [6,7,8]. To assess the diagnostic usefulness of PRPS for SOS, we retrospectively analyzed patients who developed hepatic disorder and/or ascites after allo-HCT and then underwent transjugular liver biopsy and PRPS assessment.

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Acknowledgements

The authors would like to thank the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant (number 17K09017).

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Authors and Affiliations

  1. Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hiroshi Okamura, Hideo Koh, Teruhito Takakuwa, Kentaro Ido, Yosuke Makuuchi, Shoji Ine, Satoru Nanno, Yasuhiro Nakashima, Takahiko Nakane, Masayuki Hino & Hirohisa Nakamae

  2. Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Atsushi Jogo, Akira Yamamoto & Masao Hamuro

  3. Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Kohei Kotani, Joji Kawabe, Shigeaki Higashiyama, Atsushi Yoshida & Susumu Shiomi

  4. Department of Pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Masahiko Ohsawa

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Correspondence to Hiroshi Okamura.

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Okamura, H., Koh, H., Takakuwa, T. et al. A noninvasive diagnostic approach using per-rectal portal scintigraphy for sinusoidal obstruction syndrome after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 55, 470–472 (2020). https://doi.org/10.1038/s41409-019-0537-x

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