sodium-pertechnetate-tc-99m and Hemangioma

A 43-year-old woman with papillary thyroid cancer prepared for I ablation after total thyroidectomy. With a history of type 2 diabetes for 10 years, she recently presented with periodontitis, candidiasis, and mouth dryness. TcO4 scintigraphy was ordered to evaluate function of the salivary glands. The scintigraphy incidentally found a focal TcO4 uptake in the left supraclavicular region. The subsequent neck ultrasonography showed a hypoechoic soft tissue mass with heterogeneous hypervascularity, suggestive of hemangioma.

Topics: Adult; Biological Transport; Carcinoma, Papillary; Female; Hemangioma; Humans; Incidental Findings; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Soft Tissue Neoplasms; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy

The aim of the study is the assessment of the value of SPECT (single photon emission computerized tomography) using 99mTc-labeled red blood cells in the detection of liver hemangioma, in comparison to planar imaging. With planar red blood cell scintigraphy, sensitivity of the method was 76%, specificity 98%, positive predictive value 98% and negative predictive value 79%. With SPECT, sensitivity of the method was 95%, specificity 98%, positive predictive value 98% and negative predictive value 94%. The smallest lesion detected by planar red blood cell scintigraphy was 1.2 cm, and with SPECT red blood cell scintigraphy 0.8 cm. The use of 99mTc-labeled red blood cells SPECT improved the sensitivity much more in smaller lesions (0.8 to 2 cm), than in bigger ones (2-5 cm). SPECT with radiolabeled red blood cells significantlyy improves the results of scintigraphic findings, especially in the small lesions.

Topics: Adult; Erythrocytes; Female; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Young Adult

Hepatic radionuclide angiography (HRA) is a recognised method of investigation of liver blood flow disorders caused by: diffuse and focal diseases of liver parenchyma or disorders of blood flow in extrahepatic liver vessels. Hepatic perfusion index (HPI) based on Sarper's slope method is significantly lower in patients with e.g. liver cirrhosis, malignant primary and metastatic liver diseases and portal vene thrombosis, but not in patients with benign focal liver leasions. Determined in liver as a whole, HPI is a sensitive indicator of the presence of malignant liver tumours, but is within normal range in patients with hepatic hemangioma. The aim of the study was to investigate characteristic of blood flow in hemangioma itself, separately from but in relation to the liver blood flow, using hepatic radionuclide angiography. We have examined 12 patients with liver hemangioma confirmed mainly by positive 99mTc-labeled red blood cell scintigraphy, which diagnostic specificity for liver hemangiomas is near 100%. 8/12 hemangiomas resulted in photopenic areas on angioscintigrams, indicating lower blood flow, and rest were isoactive to surrounding liver tissue. Regions of interest have been delineated around the photopenic areas (hemangiomas) and surrounding liver tissue. Time-activity curves have been generated and slope of the fitted hepatic artery and (portal) venous portions of the hemangioma and liver curves have been determined. Perfusion indexes of hemangioma (PIH) and liver (HPI) have been calculated from the slopes, expressing portal venous flow as a portion of entire blood flow to the region. In addition, times of arrival and transit of intravenous bolus of 99mTc-pertechnetate through the hemangioma and liver tissue have also been derived from time-activity curves. Slope of the venous portion of the hemangioma time-activity curve is significantly lower then that of the venous portion of the liver curve (p < 0.01). So that, perfusion index of hemangioma (PIH = 0.34 +/- 0.12 (mean +/- SD) is significantly lower then hepatic perfusion index (HPI = 0.57 +/- 0.08) (p < 0.05). Bearing in mind interference of superimposed liver activity with that of hemangioma, these results indicate that liver hemangiomas are dominantly if not exclusively irrigated by hepatic artery branches. There are no data regarding relation between arterial and venous blood flow in liver hemangiomas determined by HRA. Obtained results are in harmony with arteriography data which confirm

Topics: Erythrocytes; Hemangioma; Hepatic Artery; Hepatic Veins; Humans; Liver Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Topics: Cecal Neoplasms; Child, Preschool; Diagnosis, Differential; Gastrointestinal Hemorrhage; Hemangioma; Humans; Male; Meckel Diverticulum; Rectum; Sodium Pertechnetate Tc 99m

Topics: Abdomen; Choristoma; Erythrocytes; Gastric Mucosa; Gastrointestinal Hemorrhage; Hemangioma; Humans; Ileal Diseases; Liver Neoplasms; Meckel Diverticulum; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Hepatic hemangiomas are the most common benign tumors of the liver. They are usually single, small, and asymptomatic. However, giant hepatic hemangiomas have been reported in the past, usually detected as incidental findings. Radionuclide blood pool imaging studies are used to confirm the presence of a hemangioma. This report describes a case of a giant hepatic hemangioma detected using intravenous total-body arteriography, done as a part of radionuclide blood pool hemangioma study. This simple addition to the regular RBC blood pool hemangioma study helps to determine the size of the liver in the early arterial phase and shows obvious increased blood pool activity in the delayed phase. It is also useful in detecting lesions in other parts of the body when present.

Topics: Adult; Female; Hemangioma; Humans; Liver Neoplasms; Radionuclide Angiography; Sodium Pertechnetate Tc 99m

We investigated the usefulness of whole-body imaging as an adjunct to spot imaging in soft-tissue vascular lesions, such as hemangiomas and vascular malformations. Spot imaging of the known lesion and whole-body imaging were performed 1-3 hours after the injection of Tc-99m RBC in 42 patients with soft-tissue vascular lesions. Whole-body imaging was considered to be useful in only two patients, who had multiple distant occult lesions in addition to large known lesions. It was suggested that the routine addition of whole-body imaging is not cost effective in patients with soft-tissue vascular lesions, although it may be beneficial for detecting occult lesions in patients with hemangiomas.

Topics: Adolescent; Adult; Aged; Blood Vessels; Child; Child, Preschool; Cost-Benefit Analysis; Erythrocytes; Female; Hemangioma; Humans; Male; Middle Aged; Neoplasms, Unknown Primary; Neoplasms, Vascular Tissue; Radionuclide Angiography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Soft Tissue Neoplasms; Whole-Body Counting

Topics: Adult; Erythrocytes; Head and Neck Neoplasms; Hemangioma; Humans; Male; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Time Factors

Topics: Erythrocytes; Hemangioma; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Erythrocytes; Hemangioma; Humans; Infant, Newborn; Liver; Liver Neoplasms; Male; Neoplastic Cells, Circulating; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The authors report on their experience with liver hemangioma (LH) diagnosis by means of a simplified method--that is, the simultaneous, in vivo, double labelling of liver reticuloendothelial system (RES) and of red blood cells (RBC) by 99mTc. Twenty-eight patients with US diagnosis of suspected LH and 15 controls were examined after sequential iv injection of SnCl2, of 99mTc-mucolloid albumin and, after liver scintigraphy, of 99mTc-pertechnetate to conclude in vivo RBC labelling. All patients underwent CT and, if necessary, CT-guided biopsy. Focal colloid defects filled after RBC labelling were shown in 20/22 patients with unquestionable LH. No colloid defects were shown in 6/28 cases (expansive process). 15/15 controls showed unchanged non-filling defects after double labelling. Finally, the authors point out that, in the diagnosis of LH, sequential double labelling of liver RES and RBC appears to be a quicker scintigraphic technique than conventional ones. Moreover, this technique has the same high specificity and sensitivity as more time-consuming ones.

Topics: Adult; Aged; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin

During a cardiac blood pool study (Tc-99m erythrocytes), there was an apparent "cold" area in the left lobe of the liver. At one hour, the prior void appeared to have filled in, suggesting an intrahepatic hemangioma. However, the changing pattern of radioactivity, and its shape, indicated that this actually represented Tc-99m pertechnetate in the gastric wall and stomach cavity. In a second case, the interval between intravenous injection of stannous pyrophosphate and Tc-99m pertechnetate was prolonged. Changing activity, again in the gastric wall and cavity, obscured part of the liver. This cleared with time, allowing hepatic evaluation. Thus, gastric pertechnetate can contribute to blood pool images of the heart or liver and multiple images may be needed to separate this component from nearby tissues.

Topics: Aged; Diagnosis, Differential; Heart; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Time Factors

This paper reports the results of a prospective study carried out to demonstrate the most important advantages of 99mTc-blood pool single emission computed tomography (SPECT) versus the established method of planar scintigraphy (PS) in the non-invasive diagnosis of liver hemangiomas. The study group comprised 40 patients in whom positive evidence of 56 hemangiomas, detected incidentally in the course of screening examinations, was established via SPECT and PS. The sensitivity of SPECT was 51/56 (91%), of PS 22/56 (39.3%); for lesions smaller than 30 mm in diameter, the sensitivity of SPECT was 31/38 (81.6%), of PS 6/38 (15.8%). All lesions with diameters of more than 30 mm were detected by both PS and SPECT. However, the SPECT method proved to be clearly superior in the identification of lesions which were smaller than 30 mm and located in unfavourable topographical sites (dorsal or subphrenic). The study proves that SPECT with 99mTc-labeled erythrocytes is the ideal complement to ultrasonography in the detection of liver hemangionas; its major advantage over TCT (transmission computed tomography) is its safe application in cases with contrast agent intolerance and hyperthyroid patients. Moreover, liver biopsies are dangerous and ill-suited for the verification of diagnosis.

Topics: Adult; Aged; Erythrocytes; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Prospective Studies; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Red blood cells labeled with technetium Tc 99m were used to evaluate the vascular nature of a subcutaneous tumor in a 12-year-old girl. The low perfusion and high blood pool that characterized the lesion were considered highly suggestive of subcutaneous cavernous hemangioma. This noninvasive method for diagnosing soft tissue hemangiomas is more specific than other imaging modalities such as ultrasound and arteriography. The usefulness and the importance of the method prior to surgical biopsy or resection are discussed.

Topics: Child; Erythrocytes; Female; Forearm; Hand; Hemangioma; Humans; Sodium Pertechnetate Tc 99m; Soft Tissue Neoplasms

Radionuclide flow studies, planar, and SPECT hepatic blood pool imaging were performed in 23 patients with 39 hepatic hemangiomas, 23 patients with primary and secondary liver tumors, 12 patients with hepatocellular disease, two patients with hepatic cysts, and 10 patients with no evidence of liver disease. The hepatic SPECT imaging identified all 39 hemangiomas as having a sequestration pattern compared with a yield of 69% (27 of 39 cases) for the planar imaging. None of the 47 other patients demonstrated this pattern. The SPECT approach is considered superior to planar blood pool imaging because of improved diagnostic yield, reduced patient imaging time, and greater ease of correlation with other cross-sectional imaging modalities.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Diagnosis, Differential; Erythrocytes; Female; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed

The possibility of using radiolabelled monoclonal antibody fragments to image uveal melanomas has been assessed in a pilot study. 99mTc labelled F(ab')2 fragments of MoAb 225.28S raised against cutaneous melanomas were used. Initially 10 patients were imaged. In five patients the clinical findings were typical of uveal melanoma. Immunoscintigraphy was positive in all five cases. In a further five patients there was doubt about the diagnosis. One was though to have a choroidal haemangioma but failed to respond to treatment and immunoscintigraphy was positive, suggesting a diagnosis of melanoma. Two patients were assigned a diagnosis of choroidal haemangioma, one of melanocytoma or possible retinal pigment epithelium carcinoma, and one of metastasis. Immunoscintigraphy was negative in all these four cases. In combination with established diagnostic tests immunoscintigraphy may have a part to play in differentiating uveal melanoma from other similar tumours.

Topics: Adult; Aged; Antibodies, Monoclonal; Choroid Neoplasms; Diagnosis, Differential; Female; Hemangioma; Humans; Immunoglobulin Fab Fragments; Male; Melanoma; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Uveal Neoplasms

Topics: Erythrocytes; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Hemangioma; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adolescent; Adult; Arteriovenous Malformations; Child; Head and Neck Neoplasms; Hemangioma; Humans; Middle Aged; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Veins

Hemangiomas are easily, quickly and relatively noninvasively detected using whole-body imaging with Tc-99m labeled RBCs. A case in which this method was used to confirm known lesions and detect additional unsuspected lesions is described. This method can also be useful in the detection and evaluation of other types of vascular malformations, such as arteriovenous communications. The lesions must be of sufficient size and flow to be seen. Applications include the examination of patients known to have one vascular malformation in a search for additional lesions and the screening of relatives of patients with familial conditions that include hemangiomas.

Topics: Adolescent; Erythrocytes; Female; Hemangioma; Humans; Neoplasms, Multiple Primary; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Erythrocytes; Female; Hemangioma; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Hemangioma; Humans; Infant, Newborn; Infant, Premature, Diseases; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

To determine the accuracy of blood-pool imaging in the diagnosis of hepatic hemangiomas, 39 patients with various focal hepatic lesions were studied. The diagnoses in these patients were made by biopsy, angiography, surgical exploration, or clinical stability for a minimum of 14 months. The diagnoses were: hemangiomas (13 patients), hepatoma (three), metastases (19), abscesses (two), and liver cysts (two). After modified in vivo labeling of red blood cells with 20 mCi (740 MBq) of 99mTc pertechnetate, an initial flow study and early (1-15 min) and delayed (1-2 hr) static images were obtained. Increased blood-pool activity with a discordant flow pattern was seen in 11 of 13 patients with hemangiomas. False-negative scans occurred in two hemangiomas with extensive fibrosis. Two of three hepatomas had increased blood-pool activity associated with increased flow in a pattern identical to the increased blood-pool activity. None of the metastatic, abscess, or cystic lesions had increased blood-pool activity at any time after injection. It is concluded that 99mTc red blood cell imaging can distinguish hemangiomas from other focal liver lesions.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cysts; Diagnosis, Differential; Erythrocytes; Female; Hemangioma; Humans; Liver Abscess; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Adult; Erythrocytes; Female; Hemangioma; Humans; Nasopharyngeal Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Scintigraphy with Tc-99m labeled red blood cells (RBCs) was used to evaluate a patient with a large cutaneous hemangioma. The usefulness of this procedure when combined with arteriography is discussed.

Topics: Abdomen; Adult; Angiography; Erythrocytes; Female; Hemangioma; Humans; Radiography, Abdominal; Radionuclide Imaging; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Technetium