Measurement of Hepatic Blood Flow by Indicator Dilution Techniques12

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Abstract
Portal circulation times and hepatic blood flow is determined by measurement of the passage and dilution of radioactive iodinated serum albumin through the liver to the periphery following its intrasplenic injection. This pathway can be timed and followed by a scintillation counter placed externally over the liver and/or by scintillation well counting of blood collected continuously from the hepatic vein and the brachial artery. Liver blood flow can be measured by application of the Stewart-Hamilton principle to either the hepatic vein or surface recorded radioactive dilution curve. The technique satisfies the basic requirements of an indicator dilution method except when applied to patients with pre-hepatic shunts. Methods for calibrating the total volume of effective intrasplenic injectate based on predetermined blood volume are presented. The method was reproducible in 5 patients; similar hepatic flow values were obtained by both hepatic venous and surface scintillation counting techniques in 13 patients and compared well with the bromsulfalein method in 6 patients. Hepatic blood flow averaged 0.7 L per minute/M2 at rest in normal individuals. Normal spleen to liver arrival circulation time averaged 2.1 seconds; intrahepatic circulation time averaged 9.9 seconds.