technetium-tc-99m-sulfur-colloid and Fatty-Liver

Topics: Amyloidosis; Colloids; Fatty Liver; Glycogen Storage Disease; Granuloma; Hepatitis, Viral, Human; Hodgkin Disease; Humans; Liver Cirrhosis; Liver Diseases; Liver Diseases, Alcoholic; Liver Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

We report a case of 19-year-old male with an underlying case of chronic hepatitis C infection who suffered from two types of benign liver tumor: focal nodular hyperplasia (FNH) and pseudotumor due to focal fatty spared area in a fatty liver. These two kinds of lesions rarely occur simultaneously. The spectral Doppler ultrasound (US) images of these lesions were also provided. We suggest that spectral Doppler US provides an alternative diagnostic tool for the differentiation of liver tumors regarding their vascular pattern, which might help ensure a correct diagnosis.

Topics: Adult; Angiography; Biopsy, Needle; Diagnosis, Differential; Fatty Liver; Focal Nodular Hyperplasia; Granuloma, Plasma Cell; Hepatitis C; Humans; Male; Technetium Tc 99m Sulfur Colloid; Ultrasonography, Doppler

Topics: Adult; Fatty Liver; Female; Humans; Liver; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Focal fatty infiltration of the liver may be mistaken for metastatic disease, primary tumor or other space-occupying lesions on CT or ultrasound. Usually, a 99mTc-sulfur colloid scan is sensitive in documenting the presence of Kupffer's cell in such a process. We present a case that was suggestive of focal fatty infiltrate on a CT scan, nondiagnostic on ultrasound, and seen as a large focal defect on the 99mTc-sulfur colloid liver/spleen scan. A 133Xe inhalation study, however, did show uptake in the area of fatty infiltration. A needle biopsy confirmed the diagnosis.

Topics: Fatty Liver; Female; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Xenon Radioisotopes

Topics: Fatty Liver; Humans; Liver; Male; Middle Aged; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

The characterization of focally spared areas in a fatty liver may at times be problematic. This report illustrates the unique diagnostic role that combined xenon-133/technetium-99m sulfur colloid scintigraphy can play in such cases.

Topics: Diagnosis, Differential; Fatty Liver; Female; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Xenon Radioisotopes

Xenon-133 hepatic retention ratio was developed for quantifying fatty liver. Data were acquired in frame mode in the hepatic region and both lung bases for 5 min after rebreathing 20 mCi of gaseous 133Xe and for another 5 min during washout. Static [99mTc]sulfur colloid liver imaging was performed with the patient in the identical position immediately after the ventilation study and data were stored for liver localization. A hepatic time-activity curve corrected for background activity was generated. The 133Xe retention ratio was derived by dividing the activity at 3.5 min after washout by the peak activity. The data of 16 controls and 20 patients with fatty liver were analyzed. The retention ratio (mean +/- s.d.) was greatly increased in patients with fatty infiltration (0.43 +/- 0.20 vs. 0.04 +/- 0.08 in controls, p less than 0.001). There was a strong positive correlation between the 133Xe retention ratios and percentage of fat on biopsy as assessed by the amount of the liver tissue occupied by fat globules on H & E stained sections. The 133Xe hepatic retention ratio is a simple, accurate and clinically useful index of detecting, quantifying and managing fatty infiltration of the liver.

Topics: Adult; Fatty Liver; Female; Humans; Liver; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Xenon Radioisotopes

Six patients undergoing computed tomographic (CT) evaluation for possible abdominal and pelvic metastases were shown to have diffuse fatty infiltration of the liver and findings indeterminate for hepatic metastases. In two patients with diffuse fatty infiltration and no focal hepatic lesions on CT, technetium-99m sulfur colloid imaging demonstrated focal hepatic defects confirmed to represent metastases. In four patients with diffuse fatty infiltration and hyperdense liver foci on CT, radionuclide imaging demonstrated normal uptake in the hyperdense foci confirmed to represent areas of normal liver spared by fatty infiltration. In each of the six patients, clinical management was altered by the radionuclide findings.

Topics: Fatty Liver; Female; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

In 75 patients ultrasound (US) demonstrated fatty infiltration of the liver with diffuse increased echogenicity except for a solitary hypoechogenic area located in the quadrate lobe. The liver was also followed-up with US, computed tomography (CT), radionuclide scintigraphy, and fine needle biopsy: a skip area unaffected by steatosis was thus demonstrated. This study and further information found in literature allowed the authors to identify the particular US features which lead to a correct interpretation of these findings, which might otherwise be incorrectly diagnosed as suggestive of substitutive lesions (primary or secondary). These features are: 1) the location of skip areas, usually in the IV segment, in close relationship to a portal vessel; 2) their morphology, triangular, or inverted-V shaped; 3) the absence of mass effects upon the hepatic border and/or upon the adjacent vessels; 4) the presence of fatty liver infiltration; 5) the coexistence of a biohumoral pattern significant for diffuse hepatopathy; 6) the lack of change in US patterns during the follow-up.

Topics: Biopsy; Fatty Liver; Follow-Up Studies; Humans; Liver; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Fatty Liver; Female; Humans; Liver; Liver Circulation; Male; Middle Aged; Obesity; Plethysmography; Technetium Tc 99m Sulfur Colloid

Fatty infiltration of the liver may cause a range of focal abnormalities on hepatic sonography which may simulate hepatic nodular lesions. Discrete deposits of fat or islands of normal tissue which are uninvolved by fatty infiltration may stand out as potential space-occupying lesions on the sonograms. Twelve patients with such focally abnormal ultrasound images were referred for liver scintigraphy with 133Xe and 99mTc colloidal SPECT studies to clarify the issue. These examinations helped identify, in nine of 12 patients, the innocent nature of the sonographic abnormalities which were simply related to the fat deposition process. Further, [99mTc]RBC scans defined the additional pathologic process in three patients in whom actual space-occupying lesions were indeed present in the liver. Scintigraphy has an important role to play in the understanding of focal hepatic ultrasound abnormalities particularly in unsuspected hepatic steatosis.

Topics: Aged; Aged, 80 and over; Breast Neoplasms; Erythrocytes; Fatty Liver; Female; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Ultrasonography; Xenon Radioisotopes

Diffuse pulmonary uptake of sulfur colloid was seen in a 35-year-old postpartum white female with the presumptive diagnosis of fatty liver disease of pregnancy. As the disease process resolved, the pulmonary uptake of sulfur colloid disappeared. To the authors' knowledge, this scan association has not been previously reported.

Topics: Adult; Fatty Liver; Female; Humans; Lung; Pregnancy; Pregnancy Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Focal fatty infiltration of the liver (FFIL) occasionally may be mistaken as metastatic disease, primary liver malignancy, or other space-occupying lesions on CT or ultrasound studies, especially if there is significant mass effect. In these confusing cases, Xe-133 liver imaging has been advocated for confirmation of FFIL, since such studies have been reported to be sensitive and specific. The authors present results of four Xe-133 and four Tc-99m sulfur colloid scans in six patients with FFIL. Xe-133 imaging was found useful for diagnostic confirmation in only one patient and was misleading in the other three. Routine liver-spleen imaging was a more reliable method of confirmation, since no focal defects were found in any of the patients.

Topics: Fatty Liver; Humans; Liver; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography; Xenon Radioisotopes

In a review of 60 patients with fatty infiltration of the liver documented by Xe-133 imaging, 43% had normal radiocolloid liver images, and 57% had abnormal images with various combinations of hepatomegaly, mottling, splenomegaly, and splenic shift of radioactivity. None, however, showed focal defects. Fatty infiltrates do not simulate mass lesions on the radiocolloid study of the liver, and an area of photon deficiency in the presence of hepatic steatosis points to an additional pathologic process. The interpretation of the radiocolloid liver image is unhindered by fatty infiltration when searching for discrete space-occupying lesions.

Topics: Adult; Aged; Fatty Liver; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Xenon Radioisotopes

The authors here describe a number of imaging features which together are distinctive and may be diagnostic of focal fatty infiltration of the liver.

Topics: Adult; Diagnostic Imaging; Fatty Liver; Female; Humans; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography; Xenon Radioisotopes

A Xe-133 hepatic study was misleading when the absence of Xe-133 localization in an area of low CT numbers was considered to be negative for a diagnosis of focal fatty infiltration.

Topics: Biopsy, Needle; False Negative Reactions; Fatty Liver; Female; Humans; Imino Acids; Liver; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Xenon Radioisotopes

We compared light pen (LPEN) and Region of Interest (ROI) computer methods in determining spleen-to-liver (S/L) ratios both in anterior and posterior images in various liver diseases. The S/L ratio was independent of age or type of colloid used (equal particle size provided). Results with corresponding LPEN and ROI programs did not differ significantly from each other. The sensitivity and specificity were tested and the anterior view yielded somewhat better results than the posterior view but the best results were obtained when both projections were used. The sensitivity for all liver diseases was 60% and the corresponding specificity 93%. In hepatocellular diseases the sensitivity was 80-100%, but the S/L ration had only 37% sensitivity for hepatic metastases. Hepatomegaly in the anterior view was found in 67% of fatty liver cases, in 25% of cirrhosis cases, in 20% of hepatitis and in 25% of metastatic livers. Splenomegaly was noted in 39-54% of patients with hepatocellular diseases but only in 4-10% of metastatic diseases.

Topics: Adult; Aged; Fatty Liver; Hepatitis; Humans; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spleen; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds

Ten patients with fatty liver, distinct from the well known diffuse alcoholic variety, comprise this report. All patients had an initial ultrasound examination followed by 99mTc-sulfur colloid liver and computed tomography (CT) body scans. Six patients had focal fatty infiltration producing a space-occupying mass within the liver. Four had ultrasound evidence of diffuse fat occurring in association with focal masses. These masses were all echo poor relative to the adjacent fat, and were subsequently found to represent nodules of normal uninvolved liver in two patients, and metastatic neoplasm and multiple liver cysts in single patients respectively. The clinical picture associated with fatty liver is variable and may include, in addition to alcohol abuse, obesity, malnutrition, exogenous glucocorticoids, diabetes mellitus, and other less well defined factors. Dramatic improvement in fatty liver occurred in two patients following appropriate therapy. The spectrum of changes produced by fatty infiltration of the liver on ultrasonic, radionuclide, and CT scans is extremely varied depending on the amount of fat deposition, its focal or generalized nature, and the presence of associated liver disease.

Topics: Adult; Fatty Liver; Female; Follow-Up Studies; Humans; Male; Middle Aged; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Fatty Liver; Female; Humans; Liver Neoplasms; Middle Aged; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Liver blood flow was measured by dynamic 99Tcm-sulfur colloid accumulation and indocyanine green disappearance in 5 subjects, and by 99Tcm-sulfur colloid accumulation and 133Xe-wash-out in 7 subjects. Results obtained by the 99Tcm-sulfur colloid and indocyanine green methods were closely comparable, whereas the flow values estimated by the two isotope methods did not correlate well.

Topics: Adult; Aged; Fatty Liver; Female; Hepatitis; Humans; Indocyanine Green; Liver Circulation; Liver Cirrhosis, Biliary; Liver Diseases; Male; Methods; Middle Aged; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Xenon Radioisotopes