technetium-tc-99m-lidofenin and Carcinoma--Hepatocellular

To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist.. 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof.. On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection.. Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Echinococcosis, Hepatic; Fatty Liver; Hemangioma; Humans; Hyperplasia; Liver; Liver Diseases; Liver Neoplasms; Polysaccharides; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Lidofenin; Ultrasonography, Doppler

Hepatic arterial embolization (HAE) is the treatment of choice for inoperable hepatocellular carcinoma. There are functional changes following HAE in the tumor and in the adjoining normal liver and biliary structures. We sought to determine if a 99mTc-HIDA hepatobiliary scan could evaluate the morphological and functional changes of the liver and biliary systems in patients with hepatocellular carcinoma undergoing HAE.. Patients with hepatoma were evaluated by 99mTc-HIDA hepatobiliary scans before and after HAE.. Ten patients with histologically proven hepatomas had 44 99mTc-HIDA scans over a 319-mo period. Liver uptake was good in all patients, none developed hepatic failure. Liver tumors were detected in five of the eight studies done before the first HAE. The HIDA scan failed to locate the tumor throughout the whole study period in only one patient. Two patients showed evidence of tumor uptake of the HIDA agent. In one of these two patients the hot uptake disappeared after the HAE but reappeared after tumor recurrence. Gallbladder filling time and contractility worsened in all eight patients the day after embolization. On the HIDA scans, the gallbladder was not visualized in three of four patients who survived longer than 40 mo after HAE. Bile stasis in the left intrahepatic duct was found in six of the eight patients who survived longer than 8 mo after HAE.. Biliary complications were common in patients who received HAE, and HIDA scans may be useful for evaluating the biliary system and hot uptake in hepatocellular carcinoma in candidates for HAE.

Topics: Adult; Aged; Biliary Tract; Carcinoma, Hepatocellular; Embolization, Therapeutic; Female; Humans; Imino Acids; Liver; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Lidofenin

We report the case of a 39-yr-old female with a liver lesion that was incidentally detected by ultrasound. Examination of biopsy specimens revealed focal nodular hyperplasia. A metastatic tumor in the right os ilium developed in the following weeks and showed specific uptake of 99mTc-hepatic 2,6-dimethyliminodiacetic acid (HIDA), suggesting metastasis from a differentiated hepatocellular carcinoma. The final pathologic diagnosis was multifocal, solid and glandular hepatocellular carcinoma, partly differentiated as fibrolamellar carcinoma, and an osseous metastasis from the differentiated hepatocellular carcinoma.

Topics: Adult; Bone Neoplasms; Carcinoma, Hepatocellular; Diagnosis, Differential; Diphosphonates; Female; Humans; Ilium; Imino Acids; Liver; Liver Neoplasms; Lymphatic Metastasis; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

In a retrospective study of 160 patients who were examined within 12 months, we analysed the diagnostic value of scintigraphic techniques in the differential diagnosis of solid focal liver lesions. Haemangiomas were found in 77 patients. Bloodpool scintigraphy was true-positive in 66 (sensitivity 85%); for lesions greater than 2 cm in diameter, sensitivity increased to 94%. Metastases of CEA-expressing tumors were found in 42 patients, anti-CEA-immunoscintigraphy was true-positive in 33 patients (sensitivity 78.5%). Focal nodulary hyperplasia was found in 3 patients, adenomas in 6 patients. In the remaining 32 patients we saw 4 hepatocellular carcinomas, 28 metastases from lung and breast cancer, 2 echinococcus cysts and 1 choledochus cyst.

Topics: Adenoma; Adult; Aged; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Hemangioma; Humans; Hyperplasia; Imino Acids; Liver; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Lidofenin

A case of multiple primary cancers, hepatoma and seminoma, was detected by 67Ga citrate and 99mTc-HIDA scintigraphy. 67Ga citrate accumulated in the chest wall, the hepatic lesion and the testis. 99mTc-HIDA accumulated in the chest wall. Therefore we suspected that the chest wall lesion was a tumor metastasized from hepatocellular carcinoma and another cancer was present in the testis. After these examinations orchiectomy and needle biopsy were done. Pathologically, the testicular tumor was seminoma and hepatic and chest wall tumors were hepatocellular carcinoma (Edmondson-II).

Topics: Carcinoma, Hepatocellular; Citrates; Citric Acid; Dysgerminoma; Gallium Radioisotopes; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Neoplasms, Multiple Primary; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Testicular Neoplasms

Twelve patients with hepatocellular carcinoma and multiple metastatic pulmonary nodules were studied with Tc-99m HIDA imaging. Lung scanning was performed 1, 2, 3, 4, and 5 hours after administration of 6 mCi of Tc-99m HIDA with a preset count format of 400 K. In two patients, pulmonary uptake was clearly seen at 1 hour; in the other two patients, uptake could not be detected until 3 hours later. The overall detection rate of 33% suggests that Tc-99m HIDA has limited usefulness as a routine diagnostic tool in the detection of hepatoma metastases. The uptake may include both specific and nonspecific mechanisms.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Female; Humans; Imino Acids; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin

A patient presented with a 10-cm mass in the left lobe of the liver. Liver biopsy revealed hepatocellular carcinoma with abundant bile staining. A chest roentgenogram showed a 13-mm nodule in the right mid-lung field. A 99Tc HIDA scan was ordered for the evaluation of the pulmonary nodule. Intense uptake of the radionuclide was noted in the location of the nodule. The findings in this case suggest that the 99Tc HIDA scan may be a useful staging agent after the diagnosis of hepatocellular carcinoma has been documented.

Topics: Carcinoma, Hepatocellular; Humans; Imino Acids; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Carcinoma, Hepatocellular; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Four consecutive cases of proven hepatocellular carcinoma (HCC) showed significant avidity of 99mTc -labeled iminodiacetic acids (Tc- IDAs ) in preoperative scintigraphy. In one patient, the pulmonary metastasis showed uptake of Tc-IDA. Such scintigraphic findings were obvious only in the delayed scans, performed 2 1/2-4 hr after injection. Since Tc- IDAs and bilirubin are functional analogs physiologically, the ability of HCC to concentrate Tc- IDAs may be related to the ability of HCC neoplastic cells to form bile intracellularly. This hypothesis is supported by the fact that intracellular bile granules were found in the tumor cells of all four patients. This suggests a potential for using Tc- IDAs for the specific and preoperative diagnostic of HCC.

Topics: Adult; Bile; Carcinoma, Hepatocellular; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin

Topics: Adenoma, Bile Duct; Adult; Carcinoma, Hepatocellular; Female; Gallium Radioisotopes; Humans; Imino Acids; Liver Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

The difficulty of clinical and radiographical diagnosis of hepatoma is discussed. A case of hepatoma is reported. Both the primary tumor and distant metastases showed strong avidity for 99mTc-HIDA, which normally is concentrated by parenchymal cells of the liver. The potential of using 99mTc-HIDA for the noninvasive investigation of patients suspected of having hepatoma is discussed. The association between tumor avidity for 99mTc-HIDA and the bile-forming ability of tumor cells is of interest.

Topics: Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Gallium Radioisotopes; Hemangioma; Humans; Imino Acids; Iodine Radioisotopes; Liver; Liver Neoplasms; Lung Neoplasms; Lymphoma; Male; Radionuclide Imaging; Rose Bengal; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Female; Humans; Imino Acids; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Carcinoma, Hepatocellular; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

This presentation will focus on the recent developments in nuclear medicine that relate to diagnosis and staging in the cancer patient. The commercial availability of new Agar cameras as well as longitudinal tomographic scanning devices has improved gallium imaging significantly. This has enhanced tumor detection and resulted in better use of gallium scanning in the cancer patient. Areas of controversy have also developed. In particular, the question of whether or not the gallium scan can be used to avoid mediastinoscopy in some case of bronchogenic carcinoma will be detailed. Techniques in nuclear medicine must be carefully integrated with other noninvasive investigation such as CT and ultrasound. At Yale, the authors have gathered considerable data indicating the best way to interact nuclear medicine radionuclide scintigraphy of the liver with the ultrasound examination. Our approach to this problem for the detection of focal disease in the liver will be discussed. 99mTc-HIDA has been proven useful in a wide variety of biliary disorders. Use of scintigraphy in the evaluation of cholangio-enteric bypass procedures in the cancer patient will be reviewed.

Topics: Adenocarcinoma; Biliary Tract Neoplasms; Carcinoma, Hepatocellular; Gallium Radioisotopes; Humans; Imino Acids; Liver Neoplasms; Lung Neoplasms; Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin