sodium-pertechnetate-tc-99m and Liver-Neoplasms

Topics: False Negative Reactions; Female; Fibrosis; Hemangioma, Cavernous; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography

The aim of this phase II study was to assess the clinical utility and safety of AFP-Scan (Immunomedics, Inc, Morris Plains, NJ), a technetium-99m (99mTc)-labeled anti-alpha-fetoprotein (AFP) Fab' imaging kit, in the evaluation of hepatocellular carcinoma (HCC), in comparison to computed tomography (CT).. Twenty-five consecutive patients with a history of HCC were examined by planar and single-photon emission computed tomography (SPECT) imaging at 6 and 24 hours after intravenous (I.V.) injection of 1 mg AFP-Scan labeled with 925 MBq 99mTc.. In 20 patients, there was a specific binding of the Fab' antibody to the tumor, whereas in four patients who presented with elevated serum AFP levels, no specific targeting was found and no malignant lesions were evident by CT or biopsy. One patient was diagnosed as false-negative by AFP-Scan. In five of six patients with normal serum AFP levels, focal uptake was demonstrated. In one case, metastatic disease in the lower abdomen was found. In all patients, diagnostically relevant information was provided by the 24-hour antibody images, especially with SPECT. Comparing AFP-Scan versus CT, the former showed a higher sensitivity (95% v 63%) and specificity (67% v 17%), with an overall accuracy of 88% versus 52% for AFP-Scan versus CT, even in patients with normal serum AFP titers. No adverse reactions or human antimouse antibody (HAMA) elevations were found in any of the patients.. AFP-Scan appears to be a promising new antibody imaging kit for the disclosure of sites of HCC and should aid in the management of these patients by revealing primary, recurrent, and metastatic disease with a single imaging modality.

Topics: Adult; Aged; Aged, 80 and over; alpha-Fetoproteins; Antibodies, Neoplasm; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Male; Middle Aged; Predictive Value of Tests; Radiopharmaceuticals; Reagent Kits, Diagnostic; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to develop a new algorithm for volume determination by single photon emission computed tomography (SPECT). Different algorithms were evaluated through phantom studies. The results show that the algorithm combining moment-preserving bilevel thresholding and best-fit Laplacian second derivative edge detection can provide the most accurate measurement of volume. Besides, this method can be utilized in different SPECT systems with no need for further phantom studies. In patient studies, the results of liver volume calculation have indicated that this is a useful technique in clinical medicine.

Topics: Algorithms; Anatomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Models, Theoretical; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Topics: Colorectal Neoplasms; Doxorubicin; Drug Carriers; Erythrocyte Membrane; Glutaral; Humans; In Vitro Techniques; Liver Neoplasms; Male; Middle Aged; Sodium Pertechnetate Tc 99m

We report the synthesis, in vitro and in vivo investigation of folate-targeted, biocompatible, biodegradable self-assembled nanoparticles radiolabelled with (99m)Tc, as potential new SPECT or SPECT/CT imaging agent. Nanoparticles with hydrodynamic size in the range of 75-200 nm were prepared by self-assembly of chitosan and folated poly-γ-glutamic acid, and then radiolabelled with (99m)Tc. The nanoparticles target tumour cells overexpressing folate receptors and internalize specifically into them to realize early tumour diagnosis detected by SPECT and SPECT/CT modalities. Rat hepatocellular carcinoma cells were used as model system. Cell specificity and tumour targeting efficacy of these nanosystems were investigated in vitro, and in vivo using SPECT and fusion nanoSPECT/CT imaging. In vitro results showed that the radiolabeled nanosystem was efficiently internalized by tumour cells. Whole-body biodistribution of the new radiolabelled, folate-targeted nanoparticles revealed higher uptake in the tumorous kidney compared to the non-tumorous contralateral side. Uptake by the lungs and thyroids was negligible, which confirmed the stability of the nanoparticles in vivo. In vivo SPECT and SPECT/CT imaging visually reinforced the uptake results and were in accordance with the biodistribution data: the new nanoparticles as a targeted contrast agent improve tumour targeting and are able to detect folate-receptor-overexpressing tumours in animal models with enhanced contrast.

Topics: Animals; Carcinoma, Hepatocellular; Chitosan; Folate Receptors, GPI-Anchored; Liver Neoplasms; Male; Nanoparticles; Particle Size; Radiopharmaceuticals; Rats; Rats, Inbred F344; Sodium Pertechnetate Tc 99m; Tissue Distribution; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The purpose of this study was to investigate the anticancer effects of combined RNA interference (RNAi) of the adenine nucleotide translocase-2 (ANT2) gene and ganciclovir (GCV) therapy for treatment of hepatocellular carcinoma cells (Huh 7) in an animal model.. The Huh 7/NTG stable cell line was established by transfection of a vector with the human sodium iodide symporter (hNIS), HSV1-sr39 thymidine kinase (tk), and enhanced green florescent protein (EGFP) fusion gene into Huh 7 cells. mRNA expressions of these genes were evaluated by RT-PCR analysis. The functions of hNIS and HSV1-sr39tk were verified with (125)I uptake and (3)H-penciclovir (PCV) uptake tests. EGFP and hNIS expression was confirmed with confocal microscopy after immunocytochemical staining. We treated the tumor cells with ANT2 shRNA or GCV or both ANT2 shRNA and GCV and treated the in vivo mouse model with a Huh 7/NTG tumor xenograft. The therapeutic effects of the in vivo study were assessed with caliper measurements and gamma camera imaging using (99m)Tc-pertechnetate.. Huh 7/NTG cells showed a cell number-dependent increase in (125)I uptake and a 24-fold higher (3)H-PCV uptake compared to parent Huh 7 cells. Huh 7/NTG cells transfected with ANT2 shRNA had lower ANT2 mRNA expression and more impaired proliferation activity than cells transfected with scramble shRNA. Proliferation of Huh 7/NTG cells was also inhibited by GCV treatment. Combined GCV and ANT2 shRNA therapy further inhibited cell proliferation in the in vitro study. The combined therapy with GCV and ANT2 shRNA showed a further decrease in tumor growth in the mouse model.. Our results suggest that the combined RNA interference with ANT2 and GCV therapy inhibited hepatocellular carcinoma cell proliferation more than single GCV therapy or ANT2 shRNA therapy in vitro and in vivo. Therefore it could be applied treating incurable hepatocellular carcinoma.

Topics: Adenine Nucleotide Translocator 2; Animals; Biological Transport; Carcinoma, Hepatocellular; Cell Line, Tumor; Cell Survival; Cell Transformation, Neoplastic; Ganciclovir; Herpesvirus 1, Human; Humans; Liver Neoplasms; Mice; Prodrugs; Radionuclide Imaging; RNA Interference; Sodium Pertechnetate Tc 99m; Thymidine Kinase

The aim of the study is evaluation of the possible role of the scintigraphic estimation of the relative liver perfusion in diagnosis and the choice of treatment of liver carcinomas.. Hepatic perfusion index was obtained by dynamic scintigraphy in 126 patients.. In the control group values did not differ from the value in the patients with benign tumors (p > 0.05). However, in hepatocellular carcinoma and liver metastases of different tumors, HPI values were significantly decreased in comparison to controls and benign tumors (p < 0.01), but they didn't differ between themselves (p > 0.05). The values were especially low in the patients with malignant diseases in the liver accosciated with vascular disturbances in the portal system.. HRA could be easily done during the different conventional nuclear medicine methods. It can be an useful method for the assessment of different degrees of hemodynamic alterations in portal system, for differential diagnosis of benign and malignant liver tumors, as well as for assessment of the liver tissue and tumor perfusion, which might be helpful in the decision making for the undertaking of intraarterial (radionuclide, chemotherapy etc.) therapy.

Topics: Carcinoma, Hepatocellular; Humans; Liver Circulation; Liver Neoplasms; Portal Vein; Radionuclide Angiography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

(99m)Tc-macroaggregated albumin ((99m)Tc-MAA) scanning precedes radioembolization of the liver to detect extrahepatic shunting to the lung or gastrointestinal tract. Despite strict preventive measures in the production of (99m)Tc-MAA and in scanning protocols, the images frequently show a gastric concentration of free (99m)Tc-pertechnetate, hindering accurate evaluation of the gastroduodenal region. Our aim was to evaluate whether oral administration of sodium perchlorate (NaClO(4)) before (99m)Tc-MAA scanning will improve its accuracy by blocking free (99m)Tc-pertechnetate gastric uptake.. In 144 patients, 171 diagnostic hepatic angiograms combined with a (99m)Tc-MAA scan were performed; 86 angiograms were performed after oral administration of NaClO(4), and 85 were performed without this premedication. Clinical follow-up, esophagogastroduodenoscopy, and angiography served as reference standards.. (99m)Tc-MAA studies showed tracer uptake in the gastric region of 25 patients who did not receive NaClO(4). The uptake was interpreted as a free (99m)Tc-pertechnetate concentration in 21 studies and as a (99m)Tc-MAA accumulation in 4 studies. In 5 patients with a free (99m)Tc-pertechnetate concentration, aberrant vessels were detected in angiographic reexamination, and 3 patients developed gastrointestinal ulcer. In 7 studies, gastric findings viewed pretherapeutically as free (99m)Tc-pertechnetate were retrospectively classified as equivocal. Of the patients receiving NaClO(4), 2 showed gastric accumulation of (99m)Tc-MAA but no equivocal or free (99m)Tc-pertechnetate. Oral administration of NaClO(4) increased the negative predictive value and accuracy of the test concerning the detection of gastric perfusion from 68% and 69%, respectively, to 93% and 94%, respectively.. Oral administration of NaClO(4) before the test angiogram with (99m)Tc-MAA resulted in effective avoidance of free (99m)Tc-pertechnetate concentration and, consequently, of equivocal findings in the gastroduodenal region. This technique increased test accuracy and reporter confidence, saved time in reviewing the angiograms, and can improve treatment planning and reduce therapeutic side effects.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Biological Transport; Embolization, Therapeutic; Gastric Mucosa; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Perchlorates; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Sodium Compounds; Sodium Pertechnetate Tc 99m; Stomach; Technetium Tc 99m Aggregated Albumin

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

Topics: Adult; Erythrocytes; False Positive Reactions; Female; Histiocytoma, Benign Fibrous; Humans; Liver; Liver Neoplasms; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

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

Somatostatin receptor scintigraphy (SRS) is being increasingly used both for localization and, in some cases, diagnosis of various diseases. There are no prospective studies of its specificity or occurrence of false-positive results and their effects on management. This study was designed to address both of these issues.. Over a 40-mo period, 146 consecutive patients with Zollinger-Ellison syndrome (ZES) undergoing 480 SRS examinations were studied prospectively. Patients were admitted at least yearly and underwent SRS as well as conventional imaging studies (ultrasonography, CT, MRI) and angiography, if necessary. All admissions were assigned to one of five different clinical categories in which imaging studies had different purposes. SRS localizations were classified as true-positive or false-positive based on preset criteria. A false-positive result was determined to change clinical management based on five preset criteria.. Of all SRS examinations, 12% resulted in a false-positive localization for a neuroendocrine tumor or its metastases, resulting in a sensitivity of 71%, specificity of 86% and positive and negative predictive values of 85% and 52%, respectively. Extra-abdominal false-positive localizations (2/3) were more common than intra-abdominal (1/3). Thyroid disease, breast disease and granulomatosis lung disease were the most frequent causes of extra-abdominal false-positive localizations. Accessory spleens, localization to previous operative sites, renal parapelvic cysts and various procedural aspects were the most frequent causes of intra-abdominal false-positive localizations. Of all SRS studies, 2.7% resulted in a false-positive result that altered management.. False-positive SRS localization occurs in 1 of 10 patients with ZES. By having a thorough understanding of diseases or circumstances that result in false-positive localization and comparing the SRS result with the clinical context, the percentage of patients in whom false-positive localization results in altered management can be reduced to below 3% and the correct diagnosis made in almost every case.

Topics: False Positive Reactions; Female; Gastrinoma; Humans; Indium Radioisotopes; Liver Neoplasms; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Somatostatin; Time Factors; Zollinger-Ellison Syndrome

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

To investigate the significance of increased perfusion associated with some hepatic hemangiomata during radionuclide blood volume imaging.. Immediate dynamic planar projections and delayed SPECT imaging of a hepatic lesion were obtained after the administration of Tc-99m-labeled RBC. Scintigraphic data were compared with X-ray CT, contrast angiography and postresection histopathology.. A surgically proven, cavernous hemangioma with typical findings on delayed radionuclide blood-pool imaging showed markedly increased perfusion by scintigraphy. This correlated with arterioportal venous shunting (AVPS) on contrast angiography.. Increased perfusion on radionuclide blood-volume imaging of hepatic hemangiomata may be a scintigraphic marker of AVPS. This may serve to identify patients with increased risk for spontaneous rupture or may identify them for the development of portal hypertension.

Topics: Blood Volume; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Hyperemia; Liver Neoplasms; Middle Aged; Portal Vein; Radiopharmaceuticals; Risk Factors; 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

An 82-year-old man had his third episode of melanotic stool. Two previous workups had failed to localize the source of bleeding. A Tc-99m labeled RBC scan visualized the gallbladder early in the study. Administration of sincalide visually decreased the activity, confirming gallbladder activity. Three months later, at his second surgery, hepatic metastases were finally identified as the source of bleeding. In retrospect, the hepatic activity is inhomogeneous with at least two cold defects that could have represented hepatic metastases.

Topics: Adenocarcinoma; Aged; Diverticulum; Erythrocytes; Gallbladder; Gastrointestinal Hemorrhage; Hemobilia; Humans; Jejunal Diseases; Liver Neoplasms; Male; Neoplasms, Unknown Primary; Radionuclide Imaging; Sincalide; Sodium Pertechnetate Tc 99m

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

The purpose of this study was to review our experience with 99mTc-red blood cell scintigraphy for diagnosis of cavernous hemangiomas of the liver using a new three-headed, high-resolution dedicated SPECT system. Of 19 patients referred with a total of 38 lesions seen on CT, US, or MRI, 14 patients had 24 lesions that were hemangioma-positive with SPECT (all true-positives). Six of these 14 patients also had 9 hemangioma-negative lesions; all were less than or equal to 1.3 cm in size and false-negative. The remaining five patients had hemangioma-negative lesions only (1 false-negative, 4 true-negatives). Two hemangiomas were seen by SPECT that were not detected by CT, US, or MR. The sensitivity for hemangiomas greater than or equal to 1.4 cm. was 100% (20/20). The sensitivity was 33% for lesions 0.9-1.3 cm, and 20% for lesions less than or equal to 0.8 cm. The smallest hemangioma detected was 0.5 cm. These results show a definite improvement in sensitivity with high-resolution triple-headed SPECT over previously reported results using single-headed SPECT. High-resolution SPECT has improved our ability to detect small cavernous hemangiomas of the liver.

Topics: Erythrocytes; Female; Gamma Cameras; Hemangioma, Cavernous; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

The behavior of an anti-cancer drug consisting of transcatheter hepatic segmental arterial chemoembolization using Lipiodol mixed with an anti-cancer drug followed by gelatin sponge (segmental Lp-TAE: Seg-Lp-TAE) was assessed in comparison to that of the non-segmental Lp-TAE to whole liver (Lp-TAE) by means of Tc-99m pertechnetate (RI). Injection of Lipiodol mixed with Adriamycin and 740 mBq of RI followed by gelatin sponge was carried out from segmental or subsegmental hepatic artery in 12 cases of hepatocellular carcinoma and from proper or right hepatic artery in 11 cases (9 with hepatocellular carcinoma and 2 with metastatic liver tumor). The distribution and retention of RI were studied from the time activity curves of ROIs in tumor and non-tumor area, and scintigrams at 4 and 24 hours after injection. The integral value ratio of tumor to non-tumor was significantly higher in Seg-Lp-TAE, indicating that es the distribution of RI after Seg-Lp-TAE is selective in the segments where tumor exists. In Seg-Lp-TAE, the T1/2 was higher and the count ratio of tumor to non-tumor was significantly higher at 4 hours and even higher at 24 hours after injection. These results suggest that an anti-cancer drug reinforces the effect on tumor with little adverse effect on normal liver in Seg-Lp-TAE, which is more advantageous to the treatment of hepatocellular carcinoma.

Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Embolization, Therapeutic; Gelatin Sponge, Absorbable; Hepatic Artery; Humans; Infusions, Intra-Arterial; Iodized Oil; Liver; Liver Neoplasms; Male; Middle Aged; 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

Giant hemangiomas of the liver are clinically distinct from smaller and more innocent hemangiomas as they are more prone to complications. On imaging with ultrasound, they can also be readily confused with hepatoma, metastatic disease, or focal nodular hyperplasia. Nine giant hemangiomas (maximal diameter greater than 8 cm) were studied by scintigraphy and ultrasound. In all instances, the fill-in of the lesion on [99mTc]RBC scintigraphy indicated the diagnosis of hemangioma, adding specificity to the screening sonographic study. The pattern of fill-in on scintigraphy also appeared to be size dependent with lesions less than 11 cm in diameter equilibrating uniformly, while larger abnormalities intensified in centripetal fashion.

Topics: Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Ultrasonography

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

Evaluation of "Gianturco-Wallace chemotherapy pulser," which was developed to produce a more homogeneous drug distribution of the tumors in intra-arterial infusion chemotherapy, was assessed by comparative study of pulsed and nonpulsed arterial radionuclide infusion using Tc-99m pertechnetate for 18 cases of hepatic carcinomas (11 cases of hepatocellular carcinomas and 7 cases of metastatic hepatic carcinomas). Tc-99m pertechnetate, 740 MBq (20 mCi) diluted with saline (30 mL) was infused with or without pulse through the catheter into the hepatic artery at a rate of 1mL per minute. The intrahepatic dynamic radionuclide distribution was analyzed by the time activity curves of ROIs in the tumor and nontumor areas. Pulsed infusion interrupted laminar flow and produced more homogeneous radionuclide distribution in the liver, and combination of pulsed and nonpulsed infusion also produced better radionuclide distribution in the areas of the tumors. This method using Tc-99m pertechnetate was very useful as a simulation to determine the dynamic drug distribution of the tumor and non-tumor region in intraarterial infusion methods.

Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver; Liver Neoplasms; Male; Middle Aged; Pulsatile Flow; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tissue Distribution

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

Cavernous hemangiomas are the commonest benign tumors of the liver. Unfortunately, neither US nor CT allows cavernous hemangiomas to be positively discriminated from more dangerous lesions, e.g. metastases. Blood-pool scintigraphy has been reported to be a reliable technique for diagnosing hemangiomas of the liver: in fact, among the liver lesions in which 99m Tc-red blood cells gradually accumulate, only hemangiomas present an increased accumulation of radiotracers as soon as 2 hours afterwards. To determine the present value of blood-pool scintigraphy in oncological patients, we studied 17 patients whose US staging had shown dubious focal liver lesions. This technique allowed one or more hemangiomas to be diagnosed in 15 cases, and metastatic lesions in 2 cases. Scintigraphy with 99m Tc-labelled red blood cells proves thus to be an accurate method for the identification of cavernous hemangiomas of the liver in case of dubious US findings.

Topics: Breast Neoplasms; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver; Liver Neoplasms; Neoplasm Staging; Neoplasms, Multiple Primary; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Doxorubicin; Embolization, Therapeutic; Humans; Iodized Oil; Liver Neoplasms; Male; Metabolic Clearance Rate; Middle Aged; Sodium Pertechnetate Tc 99m

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

Thirteen patients with a history of confirmed liver carcinoma were given either I131 goat polyclonal or murine monoclonal antibodies against alpha-fetoprotein (AFP), and then scanned with a gamma camera. In order to reduce background, nontarget activity, especially in the liver, blood pool, and reticuloendothelial system, 99mTc imaging agents were used for tumor image enhancement by computer-assisted subtraction. A sensitivity of 91% for the primary site, 50% for the lungs (33% for the chest area), and 75% for the abdomen and pelvis was achieved, with a specificity of 100%, 94%, and 100% for these sites, respectively. The accuracy was determined to be 93% for the liver, 86% for the lungs (77% for the chest), and 85% for the abdominal and pelvic area, resulting in an overall accuracy rate for imaging primary and metastatic hepatocellular cancer of 84% (90% if bone metastases are excluded). In two of the 13 patients, lesions that had been missed by conventional liver scintigraphy and transmission computed tomography (CT) were first shown by radioimmunodetection (RAID).

Topics: Abdominal Neoplasms; Adult; alpha-Fetoproteins; Antibodies; Antibodies, Monoclonal; Carcinoma, Hepatocellular; Child, Preschool; Female; Hemangiosarcoma; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Pelvic Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Thoracic Neoplasms

The roles of single-photon emission computed tomography (SPECT) and planar imaging with technetium-99m-labeled red blood cells in the diagnosis of cavernous hemangioma of the liver were evaluated. The study group consisted of 26 consecutive patients referred for evaluation of liver lesions. A total of 23 cavernous hemangiomas were found, all of which showed decreased or normal flow and delayed uptake of the radiotracer. SPECT demonstrated 13 hemangiomas that were not detected with planar imaging; both modalities demonstrated the other ten lesions. Lesions that were not cavernous hemangiomas showed either normal (n = 6) or increased (n = 4) flow; none had delayed increased uptake on either planar or SPECT images. SPECT with labeled red blood cells is an accurate method for the detection of cavernous hemangiomas of the liver and is more sensitive than planar imaging in depicting small lesions.

Topics: Adult; Aged; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver Neoplasms; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed

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

The scintigraphic findings on sulfur colloid liver-spleen imaging, Tc-99m labeled RBC blood pool imaging, and Tc-99m MDP bone imaging in four patients with infantile hemangioendothelioma are described. Thirteen radionuclide studies were performed, with serial sulfur colloid images obtained in three patients, allowing interval assessment of liver size and tumor involvement. Findings of Tc-99m MDP uptake in the livers of two patients with hemangioendothelioma and diffuse increase in hepatic RBC labeled blood pool activity in one patient also are reported.

Topics: Child, Preschool; Erythrocytes; Female; Hemangioendothelioma; Humans; Infant; Infant, Newborn; Liver Neoplasms; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Metastatic carcinoma to the thyroid gland rarely is encountered in clinical practice; however, autopsy series have shown that it is not a rare occurrence. A case of adenocarcinoma of the colon with metastases to the thyroid is reported. A review of the literature reveals that melanoma, breast, renal, and lung carcinomas are the most frequent tumors to metastasize to the thyroid. Metastatic disease must be considered in the differential diagnosis of cold nodules on radionuclide thyroid scans, particularly in patients with a known primary.

Topics: Adenocarcinoma; Adenoma; Colonic Neoplasms; Female; Humans; Iodine Radioisotopes; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

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

Topics: Aged; False Negative Reactions; Female; Humans; Liver; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

This is a case of striking radioiodine and [99mTc]pertechnetate uptake by disseminated nonthyroidal (gastric) adenocarcinoma. A 65-yr-old man was euthyroid and serum thyroglobulin concentration was normal at 11 ng/ml. Bone-marrow biopsy showed that the metastatic tumor cells were negative for thyroglobulin on immunoperoxidase stain and the secretory product was mucicarmine-positive. We estimate that radioiodine uptake in the normal thyroid gland was less than 10% of total tumor uptake. At autopsy, the stomach was the site of the primary tumor, which had the same cellular and histochemical characteristics as the metastatic lesions in bone and liver. It is emphasized that the use of pertechnetate for screening patients with gastric adenocarcinoma may be clinically useful in the early detection of metastatic lesions.

Topics: Adenocarcinoma, Mucinous; Aged; Bone Neoplasms; Female; Humans; Iodine Radioisotopes; Liver Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach Neoplasms; Thyroid Neoplasms

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

A comprehensive radionuclide method was used: evaluation of the time course of the absorption of a colloid radiopharmaceutical, a polyposition static examination of the liver, positive scintigraphy using tumorotropic agents and indirect radionuclide angiography of the liver. It has been established that blood flow quantitative indices changed by 1.5-2 times and the prevalence of the arterial component of the hepatic blood flow in all the segments can indicate cirrhotic lesions. A sharp decrease or a complete absence of the blood supply of "cold foci" are mostly observed in abscesses or parasitic involvement of the liver. The prevalence of the arterial component of the blood supply and the lessening of the blood supply value by 40-50% in foci of the lowered accumulation of a colloid radiopharmaceutical only with the preserved blood flow in the adjacent tissues are characteristic of primary tumor or metastatic involvement of the liver.

Topics: Colloids; Gallium Radioisotopes; Humans; Indium; Liver; Liver Circulation; Liver Neoplasms; Radioisotopes; Selenomethionine; Sodium Pertechnetate Tc 99m; Technetium; Tomography, Emission-Computed

A radiolabelled monoclonal antibody was injected intravenously into two patients with disseminated carcinoma of the colon and serial scintigrams were then obtained on three consecutive days. In addition to the "specific" antibody image, blood pool and conventional liver scans were also obtained. After computer-based subtraction discrete hepatic metastases could be demonstrated in both patients, while in the second patient, the primary colonic tumour was also visualised for the first time. The study demonstrates the specific localisation of primary and secondary carcinoma of the colon with a radiolabelled monoclonal anti-tumour antibody and offers an improved method of specifically detecting tumours in man.

Topics: Adenocarcinoma; Adult; Antibodies, Monoclonal; Colonic Neoplasms; Humans; Iodine Radioisotopes; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium

Topics: Adult; Aged; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium