technetium-tc-99m-lidofenin and Liver-Neoplasms

Topics: Biliary Tract; Colloids; Gallbladder; Gallium Radioisotopes; Humans; Imino Acids; Iodine Radioisotopes; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Rose Bengal; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

The function of polygonal liver cells can be estimated by using liver specific dyes such as labelled BSP or bengalrosa and labelled X-ray contrast media. Various methods are available: clearance with blood counting or external monitoring, whole body clearance and retention measurement. These tests are of value for following the course of liver diseases. Blood flow measurements either with labelled colloids or 133 Xe are mainly used for scientific purposes. Portosystemic shunts can be detected by injection of labelled microspheres in the spleen and lung monitoring or scanning. With the dynamic scintigraphy portosystemic shunts can be visualized ( radionuclide splenoportography). The measurement of the praecordial appearance time after rectal instillation of 133 Xe permits the functional evaluation of a surgical portosystemic shunt. Dynamic scintigraphy makes possible the estimation of the arterial part of liver blood flow after i.v. injection of 99m Tc and this together with the radionuclide splenoportography allows the assessment of disturbed blood flow in patients with portal hypertension. I. v. applied parathyroid hormone increases the arterial hepatic blood flow. Preliminary results indicate that patients with portal hypertension and a good response to parathyroid hormone seem to have a good prognosis after shunt operation. The determination of red cell survival with 51 Cr is helpful in the differential diagnosis of jaundice. The specificity of liver scanning with labelled colloids for malignant diseases can be reasonably increased by additional 67 Ga-scintigraphy. In the diagnosis of hepatoma with both colloid and Galliumscan and the evaluation of alpha-fetoprotein a 90% accuracy can be achieved. The hepatobiliary transport can easily be visualized with 99m Tc labelled IDA-compounds and also in patients with severe jaundice where the X-ray cholangiopathy is impossible. This examination is indicated in patients with bile duct observations (also intrahepatic), after cholecystectomy, for the differential diagnosis of jaundice, for the demonstration of refluxes etc. The most important radioimmunological in vitro methods for the investigation of liver diseases are only briefly described.

Topics: alpha-Fetoproteins; Bile Acids and Salts; Ferritins; Gallium Radioisotopes; Hepatic Artery; Hepatitis A; Hepatitis B; Humans; Imino Acids; Liver; Liver Circulation; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Liver Neoplasms; Portasystemic Shunt, Surgical; Portography; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Xenon Radioisotopes

Bronchobiliary fistula (BBF) represents a rare but severe complication in patients affected by liver metastases. Although a clinical suspicion can arise when specific clinical signs, in particular biliptysis, are present, conventional imaging modalities often fail to confirm the diagnosis. We present a case of a patient affected by colon cancer with liver metastases previously treated with partial right-sided hepatectomy and multiple thermo-ablative treatments combined with chemotherapy, who manifested a septic fever associated with productive cough and biliptysis. Diagnosis of BBF was confirmed only by hepatobiliary scintigraphy with (99m)Tc-heptoiminodiacetic acid.

Topics: Aged; Bile; Biliary Fistula; Bronchial Fistula; Cautery; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Colonic Neoplasms; Combined Modality Therapy; Drainage; Duodenum; Escherichia coli Infections; Female; Fever; Hepatectomy; Humans; Jaundice, Obstructive; Liver Neoplasms; Radionuclide Imaging; Stents; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed

Bronchobiliary fistulas are rare, may result from infection with Echinococcus or Amebiasis, trauma, or hepatic malignancy, and present with biliptysis, the expectoration of bile. The authors present a 49-year-old woman who presented with frank biliptysis as a result of previously treated metastatic colon cancer to the liver. A hepatobiliary scan is the noninvasive diagnostic imaging test of choice for demonstration of such fistulas, and was useful in confirming the diagnosis in our patient.

Topics: Bile; Biliary Fistula; Bronchial Fistula; Female; Humans; Liver Neoplasms; Lung; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Primary cancer of the liver is characterized not only by laboratory evidence for cytolytic (87.5% cases), cholestatic (100% cases) syndromes, high levels of oncomarkers (CA-19-9, 50%; CEA, 68.75%; alpha FP, 43.75%) and activation of hemostasis system but, as shown at hepatobiligastroscintigraphy with 99m-Tc-brommeside, by at least 2-fold decline in absorptive and excretory function of hepatic polygonal cells (in 75% cases), at least a 5-fold decline in secretory function of the gallbladder (in 100% cases), cholestasis (in 100% cases) manifesting as a 3.8-fold reduction, on the average, of the ratio of secretory function of the gallbladder to that of the intrahepatic bile ducts, dilation of the latter (in 50% cases), Oddi's sphincter hypotonicity (in 50% cases). None of the patients showed duodenogastric reflux.

Topics: Adult; Aged; Biliary Tract; Biomarkers, Tumor; Female; Gallbladder; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Lidofenin

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

The aim of modern diagnostic procedures in hepato-biliary and pancreatic tumours is the characterization of origin, type and resectability of a lesion and the staging of the tumour. Furthermore, preoperative diagnostic methods should reduce the operative risk by demonstration of anatomical variations i.e. hepatic blood supply. In addition alternative therapeutic concepts like chemoembolization should be kept in mind. A diagnostic procedure in liver and pancreas tumours is demonstrated following aspects of economical and surgical requirements.

Topics: Angiography; Humans; Imino Acids; Liver Neoplasms; Organotechnetium Compounds; Pancreatic Neoplasms; Portography; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed

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

Topics: Cholecystitis; Female; Hematoma; Humans; Imino Acids; Liver Abscess; Liver Diseases; Liver Neoplasms; Male; 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: Female; Humans; Imino Acids; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Rhenium; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

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

Hepatobiliary scintigraphy with the 99mTc-labeled iminodiacetic acid derivatives has been shown to be useful in the evaluation of biliary tract diseases, especially for the diagnosis of acute cholecystitis. Little emphasis has been placed on the importance of the hepatic parenchymal image that occurs early in the imaging sequence. To determine what information can be obtained from the hepatic parenchymal image, a comparison was carried out of sulfur colloid and iminodiacetic acid images in 50 patients with focal defects. In 46 of 50 patients, the number and position of lesions on the two studies were similar, while in four patients the images were discordant. In addition to being very similar in lesion detection, the iminodiacetic acid scans also allowed more specificity in the later imaging (biliary phase) in 13 cases. The value of iminodiacetic acid derivatives in the evaluation of some biliary tract disorders has been established; considerable value can also be obtained by close inspection of the hepatic parenchymal image as well.

Topics: Adult; Bile Duct Diseases; Bile Ducts; Cholecystitis; Female; Humans; Imino Acids; Liver; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid; Time Factors

Segmental biliary obstruction as a result of primary or secondary hepatic malignancy has been reported with increasing frequency. For two representative patients, the clinical and Tc-99m HIDA scintigraphic findings in segmental biliary obstruction are described. The presence of photon-deficient dilated bile ducts in one segment of the biliary tree is highly suggestive of localized biliary obstruction and should be considered in the patient with suspected or proven hepatic malignancy despite the absence of jaundice.

Topics: Adenocarcinoma; Bile Duct Neoplasms; Cholestasis, Intrahepatic; Female; Humans; Imino Acids; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

In three cases, irradiated regions of liver failed to concentrate Tc-99m-sulfur colloid. In two of these three, imaging with Tc-99m-acetanilide iminodiacetic acid (IDA) agents within five days showed near normal hepatic uptake of this hepatobiliary imaging agent. The hepatic parenchymal cells may be imaged with Tc-99m-IDA in some irradiated regions of liver, despite loss of reticuloendothelial cell function.

Topics: Aged; Child, Preschool; Female; Gallbladder; Humans; Imino Acids; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

16 patients with a history or suspicion of malignant disease were investigated scintigraphically for liver metastases. Each patient was studied with 99mTc-HIDA and 99mTc-sulphur- or tin-colloid. In 4 patients liver metastases were suspected and confirmed by ultrasonography and/or computerized tomography. The filling defects were visible with 99mTc-colloids and 99mTc-HIDA as well. Likewise both radiopharmaceuticals coincided in their parenchymal activity patterns in the nonsuspicious livers. Because of this good agreement the morphologic aspect of basically functional 99mTc-HIDA examinations is emphasized.

Topics: Adult; Aged; Breast Neoplasms; Colonic Neoplasms; Female; Hodgkin Disease; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Technetium; Technetium Tc 99m Lidofenin; Teratoma; Testicular Neoplasms

Topics: Adult; Aged; Cholestasis, Extrahepatic; Colonic Neoplasms; False Positive Reactions; Female; Gallbladder Neoplasms; Humans; Imino Acids; Liver Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

Topics: Chronic Disease; Hepatitis; Humans; Hyperbilirubinemia; Imino Acids; Liver; Liver Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors