technetium-tc-99m-sulfur-colloid and Hepatic-Veno-Occlusive-Disease

A case of veno-occlusive disease of the liver of unknown etiology is reported. In the case, the gross abnormality of liver parenchyma, ascites, and colloid shift to spleen, bones, and lungs found on a Tc-99m SC liver-spleen scan, and confirmed on liver biopsy, resolved completely on follow-up. Histologic correlation and a brief review of the literature are presented.

Topics: Adult; Female; Hepatic Veno-Occlusive Disease; Humans; Liver; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

Nineteen bone marrow transplant (BMT) patients were studied prospectively with serial 99Tcm-sulphur colloid liver/spleen scintigraphy to determine if quantification of lung uptake aided in early identification of hepatic veno-occlusive disease (VOD). Anterior lung/liver (L/L) and geometric mean spleen/liver (S/L) ratios were determined prior to BMT conditioning chemotherapy/total body irradiation, and at 1-4 days (n = 17), 11-14 days (n = 18) and 27-33 days (n = 15) post-BMT, and correlated with the presence of VOD post-BMT employing standard clinical criteria. Veno-occlusive disease developed in nine patients (47%): mild 5; moderate 1; severe 3. Of 17 patients studied 1-4 days post-BMT, at which time no patient had objective evidence of VOD, an L/L ratio > or = 0.075 predicted subsequent development of moderate or severe VOD with a sensitivity of 100% (4/4) and a specificity of 85% (11/13). An L/L ratio > or = 0.075 on any post-BMT study had a sensitivity of 100% (9/9) and specificity of 70% (7/10) for the diagnosis of VOD of any severity. Increase in lung uptake at 4 weeks post-BMT was associated with a poor prognosis in patients with VOD, as the four with L/L ratios of 0.085-0.115 died during the first year, while the two patients with L/L ratios of 0.032 and 0.078 survived. Increased lung uptake on liver/spleen scintigraphy early post-BMT may be useful for identifying patients likely to develop significant VOD and for assessing their prognosis.

Topics: Adult; Bone Marrow Transplantation; Female; Hepatic Veno-Occlusive Disease; Humans; Liver; Lung; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Spleen; Technetium Tc 99m Sulfur Colloid; Time Factors

Three patients who developed signs and symptoms of liver dysfunction following autologous bone marrow transplantation showed varying degrees of increased lung uptake on technetium-99m-sulfur colloid (99mTc-SC) liver-spleen-scans and were subsequently demonstrated to have hepatic venoocclusive disease (VOD) at autopsy. Although increased lung uptake of labeled colloid has been noted in solid organ and bone marrow transplant patients, an association between this phenomenon and VOD has not been previously reported.

Topics: Adult; Bone Marrow Transplantation; Female; Hepatic Veno-Occlusive Disease; Humans; Liver; Lung; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid