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

The major role of nuclear medicine in clinical oncology is in tumor imaging, which includes evaluating specific organs or the entire body for the presence of tumor. Nuclear medicine studies have been used clinically in the initial evaluation of the tumor extent and in the subsequent management of the cancer patient to assess response to treatment, to detect early relapse, and to assist in making decisions concerning follow-up treatment. Technetium-99m macroaggregated albumin perfusion study for intraarterial chemotherapy has been helpful in monitoring the catheter tip, providing a map of regional perfusion at the capillary level (tumor vascularity), evaluating the degree of arteriovenous shunt in tumor bed, and optimizing division of the dose of chemotherapeutic agent when bilateral arterial catheters are used. Quantitative and serial radionuclide angiocardiography has been useful in assessing doxorubicin (Adriamycin, Adria Laboratories, Columbus, Ohio) toxicity, and 67Ga-citrate imaging has been used to monitor chemotherapy effect on lungs and kidneys. Radionuclide venography can demonstrate suspected thrombus, and the delineation of the vascular anatomy also allows proper placement of another catheter for continuous effective chemotherapy. Serial bone scans have been the primary modality to assess the response of bone metastasis to systemic therapy in breast cancer patients, and nuclear hepatic imaging may show tumor response, hepatocellular dysfunction, and cholecystitis related to chemotherapeutic agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Antineoplastic Agents; Bone and Bones; Bone Neoplasms; Chemotherapy, Cancer, Regional Perfusion; Doxorubicin; Gallium Radioisotopes; Heart Failure; Humans; Injections, Intra-Arterial; Kidney Diseases; Liver; Liver Diseases; Lung; Lung Diseases; Magnetic Resonance Spectroscopy; Neoplasms; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Thrombophlebitis; Tomography, Emission-Computed

The interaction between the various noninvasive and invasive imaging modalities used to evaluate the liver, biliary tract, and pancreas is demonstrated in this article. By understanding this interaction and correlating noninvasive studies, the clinician will avoid diagnostic redundancy and the need for invasive testing may be reduced.

Topics: Adenocarcinoma; Biliary Tract Diseases; Biopsy, Needle; Cholangiography; Cholecystectomy; Cholelithiasis; Cholestasis; Diagnosis, Differential; Hepatectomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Breast Neoplasms; Hemangioma; Humans; Liver Abscess; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Organotechnetium Compounds; Phytic Acid; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

Radionuclide techniques are currently used to fully evaluate many congenital and acquired abnormalities of the gastrointestinal tract of children. Frequently, the anatomic and functional data provided by the nuclear examination are definitive. In the study of many disease entities, tracer techniques have replaced more cumbersome or invasive procedures. Although the radiopharmaceuticals and instrumentation are similar as applied to both children and adults, the uniqueness of children and their disease entities requires special consideration when performing and interpreting their studies. In this review, the principle radionuclide examinations used in the evaluation of pediatric gastrointestinal disorders are detailed and examples are illustrated.

Topics: Bile Ducts, Intrahepatic; Biliary Tract; Biliary Tract Diseases; Child; Common Bile Duct Diseases; Computers; Cysts; Gastroesophageal Reflux; Gastrointestinal Diseases; Humans; Infant, Newborn; Jaundice, Neonatal; Liver; Liver Diseases; Meckel Diverticulum; Postoperative Care; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

A binary classification was used to evaluate the relative usefulness and accuracy of liver imaging with radiocolloid scintigraphy, ultrasonography, and transmission computed tomography. No single technique was found to be significantly superior to the others on the basis of their sensitivity, specificity, and predictive value.

Topics: Colloids; Humans; Liver; Liver Diseases; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray; Ultrasonography

Spleen enlargement is commonly associated with portal hypertension from cirrhosis and may cause thrombocytopenia. Thus, accurate assessment of spleen size may be helpful in the clinical evaluation. Spleen length is not a precise estimate of spleen size because of the variation in spleen configuration, and spleen volumes measured by edging techniques can be tedious. We present a new method of measuring the functional spleen volume by liver-spleen scan (LSSs), validation experiments and some clinical data.. The method involves measurement of the total spleen counts by SPECT and dividing by a representative voxel concentration on a single frame to obtain the organ volume. Validation included phantom studies and clinical evaluation in 443 consecutive patients, including 216 with histologic assessments of chronic liver disease (CLD) and 11 healthy volunteers.. A calibration factor determined from phantoms was used to convert the calculated volume (CV) to the "true" volume (V): V = CV (0.956) - 66.5 (r = 0.9991; P < 0.001). The volume calculations were validated in a second group of phantoms (r= 0.981; P < 0.0001). Spleen volumes were expressed as volume (cm3) and as volume per pound ideal body weight (IBW) (cm3/lb) (the conversion factor to convert cm3/lb IBW to cm3/kg IBW is 2.2). Clinical studies of reproducibility included demonstration of a significant (P < 0.0001) linear correlation between volumes calculated from repeat LSSs within 9 mo of the initial LSS in 11 healthy volunteers and 32 patients with CLD: y = 1.02x - 25; r = 0.968. The correlation with spleen volumes from autopsy or splenectomy was significant: y = 0.766x + 57; r = 0.845; P < 0.001. The normal spleen volume in 11 patients was 201 +/- 77 cm3 and 1.43 +/- 0.68 cm3/lb IBW (upper limits of normal: 335 cm3 or 2.5 cm3/lb IBW). In 443 consecutive LSSs over 15 mo, half of the patients had spleen volumes above the upper limits of healthy volunteers, and CLD was present in 90.9% of these patients. In 216 patients with histologically proven liver disease, a progressive increase in the percentage of spleen volumes above the upper limits of normal was noted from no fibrosis (10%) to mild to moderate fibrosis (36.7%) to early cirrhosis (52%) to advanced liver disease (75%). The correlation of spleen volume with platelet count was excellent (r = 0.7635; P < 0.005).. This novel spleen volume measurement detects serious liver disease and correlates with splenic hyperfunction.

Topics: Chronic Disease; Humans; Indicator Dilution Techniques; Liver Diseases; Organ Size; Phantoms, Imaging; Platelet Count; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Heterotopic liver tissue is a relatively rare finding, which has historically been discovered incidentally during surgery or at autopsy. However, we present a 28-year-old woman who presented to the emergency department with shortness of breath and stabbing chest pain. An emergent CT angiogram of the chest was performed, which incidentally revealed a mediastinal paraesophageal mass. Subsequent endoscopic ultrasound showed a hypoechoic area that appeared to connect to the liver. A liver/spleen scan with SPECT/CT with Tc sulfur colloid demonstrated that the mass was paraesophageal heterotopic liver tissue with a connection to the orthotropic liver by a small stalk.

Topics: Adult; Choristoma; Diagnosis, Differential; Female; Humans; Liver; Liver Diseases; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Talc pleurodesis can be offered to patients with hepatic hydrothorax. The authors wanted to determine their patient's eligibility for talc pleurodesis by excluding a pleural-peritoneal shunt.. The authors measured the size of the talc particles and matched them with the radionuclide particle size. After injecting radiopharmaceutical into the pleura, the authors imaged the abdomen for possible migration.. In their patient, there was no migration of radionuclide from the thorax into the abdomen.. Injecting radionuclide into the thoracic cavity and then imaging for an extended period of time is one way to determine whether the patient has a pleural-peritoneal shunt.

Topics: Aged; Female; Humans; Hydrothorax; Injections, Intraperitoneal; Liver Diseases; Patient Selection; Peritoneovenous Shunt; Pleurodesis; Radionuclide Imaging; Radiopharmaceuticals; Talc; Technetium Tc 99m Sulfur Colloid

Twelve cases of right hepatic hydrothorax are reported. Tc-99m SC that was injected intraperitoneally and intrapleurally provided evidence of a one-way flow of fluid from the peritoneal to the pleural cavity. Eight patients, whose hydrothorax was refractory to sodium restriction, diuretics and repeated thoracenteses, were treated by endopleural tetracycline instillation. The pathogenetic role of the diaphragmatic defect and the diagnostic usefulness of radionuclide imaging are stressed.

Topics: Adult; Aged; Female; Humans; Hydrothorax; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Persistent fever in a 60-yr-old man with polycystic kidney and liver diseases and bilateral hip prostheses was presented in this study. Multiple diagnostic tests failed to localize a source of infection. Subsequently, a combination of a 111In-oxine labeled WBC and 99mTc-sulfur colloid scans (and computer subtraction) demonstrated abnormally increased WBC activity in the left lobe of the liver, thus, diagnosis of an infected cyst (or cysts) was made. The patient responded to the treatment with antibiotics. This article discusses the clinical features of polycystic disease of the liver and kidneys. Infection in cysts are discussed as well as radiographic and scintigraphic investigations that can be used to diagnose and localize infection in a cyst.

Topics: Cysts; Fever; Hip Prosthesis; Humans; Indium Radioisotopes; Infections; Leukocytes; Liver Diseases; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Polycystic Kidney, Autosomal Dominant; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The perfused Kupffer cell mass determines sulfur colloid distribution by liver spleen scan (LSS) and is proportional to the perfused hepatocyte mass. This accounts for the correlation of sulfur colloid distribution with tests of hepatic function and raises the question of whether the LSS can be used as a quantitative test of hepatic function. The recent ability to precisely measure sulfur colloid distribution by single-photon-emission computerized tomography (SPECT) prompted us to evaluate the clinical value in 329 consecutive patients with adequate LSS and clinical information, of which 27 apparent normals and 220 patients with chronic liver disease (CLD) were included in this study. The liver-bone marrow index (LBI) indicated the distribution of counts between the liver and bone marrow. The liver-spleen index (LSI) indicated the distribution between liver and spleen adjusted for spleen size. The LBI and LSI correlated with each other (r = 0.753; P < 0.001). The arithmetic mean of LBI and LSI was defined as the severity score. Detailed clinical evaluation was available in these patients and included 109 who had liver biopsy. A severity score in 27 normals was 102 +/- 5 (mean +/- SD) with all values > 85. The severity score correlated with hepatic fibrosis (r = -0.694; P < 0.001) in 109 patients with benign liver disease who had recent biopsies and with the Child-Pugh classification (r = 0.78; P < 0.001) in 220 patients with CLD.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Biopsy; Chronic Disease; Humans; Kupffer Cells; Liver; Liver Diseases; Liver Diseases, Alcoholic; Liver Function Tests; Severity of Illness Index; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Hepatitis B; Hepatitis B Surface Antigens; Hepatitis, Chronic; Humans; Liver Cirrhosis, Alcoholic; Liver Diseases; Radionuclide Imaging; Splenomegaly; Technetium Tc 99m Sulfur Colloid

The purpose of the study was to determine whether a correlation between the radioisotopic "spleen-to-liver" ratio and the hepatic damage (according to Knodell's Index) exists in patients with chronic liver disease, in order to ascertain whether hepatic biopsy should be performed under visual (laparoscopic) control or not (blind liver biopsy). Thirty patients with inflammatory chronic hepatic disease were studied (9 chronic persistent hepatitis, 14 active chronic hepatitis and 7 hepatic cirrhosis). An inverse correlation was found between Knodell's Index and the "spleen-to-liver" ratio with moderate statistical significance (r = -0.46). In conclusion, the isotopic "spleen-to-liver" ratio correlates moderately well with the degree of hepatic damage and consequently it can only be used as orientation about the preferable way for obtaining a liver biopsy (laparoscopically or not).

Topics: Biopsy; Chronic Disease; Hepatitis, Chronic; Humans; Liver; Liver Diseases; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Ultrasonography

The management of focal nodular hyperplasia (FNH) of the liver requires a systematic approach. After a histologic diagnosis of FNH is obtained, asymptomatic lesions can be observed safely with regular follow-up and treated if they become symptomatic or enlargement occurs. In the case presented here, we have elected follow-up with serial CT scans because our patient is asymptomatic and the lesion has not significantly enlarged. Patients who have symptomatic lesions while taking an oral contraceptive can have conservative follow-up when they stop taking the oral contraceptive, because regression of FNH has been reported to occur after cessation of oral contraceptive use. If the patient remains symptomatic or if the lesion enlarges after discontinuance of oral contraceptive use, surgical resection is warranted. Other symptomatic patients, including those with a previous history of taking oral contraceptives, should be treated by surgical resection or, when resection is not possible, by embolization or ligation of the hepatic artery, because symptomatic patients are at risk for having malignant lesions misdiagnosed as FNH.

Topics: Female; Humans; Hyperplasia; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Middle Aged; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

To evaluate gastric emptying in patients with chronic liver disease and portal hypertension.. We measured gastric emptying of both the liquid and solid components of a meal in 10 consecutive patients with chronic liver disease and portal hypertension, but free of ascites, and 14 age- and sex-matched healthy controls. In the patients with liver disease, relationships between emptying and liver function were examined. To measure gastric emptying, subjects consumed a test meal that consisted of scrambled eggs labeled with 99mTc-sulfur colloid and 4 oz of water labeled with 111In-diethylene triamine pentacetic acid (DTPA).. Patients with liver disease and portal hypertension demonstrated delayed emptying of both the liquid (t1/2, min, mean +/- SE, patients vs.. 69.4 +/- 19.4 vs. 31.4 +/- 1.8, p < 0.01) and solid (post-lag phase solid emptying: 141 +/- 32.9 vs. 69.8 +/- 4.6, p < 0.006) components of the meal. We could not identify any correlation between gastric emptying and tests of liver function.. Gastric emptying is delayed in patients with liver disease and portal hypertension; this abnormal gastric motor function may contribute to the pathophysiology of foregut complaints in this patient population.

Topics: Adult; Chronic Disease; Female; Food; Gastric Emptying; Humans; Hypertension, Portal; Indium Radioisotopes; Liver Diseases; Liver Function Tests; Male; Middle Aged; Pentetic Acid; Technetium Tc 99m Sulfur Colloid

A prospective study was performed on 14 patients with histologically proven focal nodular hyperplasia (FNH) using a hepatobiliary scan with trimethylbromoimino-diacetic acid (TBIDA) and a colloid scan with rhenium sulfur colloids. TBIDA uptake was relatively normal in the region of the tumor, but during the clearance phase 23/25 of the tumors were detected by a hot spot of radioactivity. Depending on the relative contrast achieved between the tumor and normal liver, this hot spot appeared early or later, but was always present at 60 min. In three tumors, a "doughnut" pattern was observed within the hot spot due to a central defect. Hypervascularization was observed during the perfusion phase in 76% of the tumoral sites and normal colloid uptake in only 64%. The detectability of FNH appears greater with TBIDA (92%) than with CT or MRI (84%). The high prevalence of hot spots may be due to careful technological conditions when obtaining hepatobiliary scans. Late images, overexposed films, multiple views and stimulation of gallbladder excretion increased tumor detectability. The hot spot sign may be a useful tool when combined with the results of other imaging modalities in the diagnosis of FNH. The peculiar pathology of FNH with fibrosis, hyperplastic hepatocytes and cholangiolar proliferation might explain this scintigraphic appearance.

Topics: Adult; Aniline Compounds; Biliary Tract; Female; Glycine; Humans; Imino Acids; Liver; Liver Diseases; Magnetic Resonance Imaging; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Rhenium; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

On In-111 WBC images, diffuse homogeneous uptake of the radiopharmaceutical should be present throughout the liver. The authors present a case of a febrile patient with polycystic liver disease in whom the normal diffuse uptake was not seen. Instead, the images demonstrated focal areas of uptake, which suggested infection. Tc-99m SC liver spleen scintigraphy demonstrated the In-111 WBC foci to correspond to areas of residual normal parenchyma. The patient underwent laparotomy and liver transplantation and no abscesses were found. Pathologic examination of the liver revealed multiple uninfected cysts and residual normal parenchyma in the caudate lobe, corresponding to the findings on scintigraphy.

Topics: Cysts; Diagnosis, Differential; Humans; Indium Radioisotopes; Leukocytes; Liver; Liver Abscess; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The clinical findings in cirrhosis and systemic amyloidosis may be similar, leading to difficulties in diagnosis. We studied three patients with systemic amyloidosis with a 99mTc sulfur colloid liver-spleen scan. In all three patients, uptake by the spleen was less than the liver, in contrast with the increased splenic uptake seen in patients with cirrhosis. The liver-spleen scan may be a useful tool in differentiating patients with cirrhosis from those with systemic amyloidosis when clinical findings fail to give the proper diagnosis.

Topics: Aged; Amyloidosis; Female; Humans; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

A total of 95 patients, including 45 people with no evidence of liver disease and 50 documented hepatocellular disease patients, were studied to assess the value of planar and SPECT scintigraphy in the evaluation of hepatocellular disease. The accuracy and concordance between techniques was assessed using two criteria. Criterion 1, heterogeneity of the tracer in liver, yielded a concordance of 64%, whereas with criterion 2, liver and spleen tracer pattern, concordance was 78%. SPECT was significantly more accurate than planar imaging (P < 0.01), using both criteria. The clinical severity of the hepatocellular disease was further assessed in 72 of the patients and correlated with a liver scan severity rating scale. The SPECT technique showed a good correlation (r = 0.89) with the composite clinical severity score; however, no significant relationship with planar imaging was noted. The results of this study suggest that liver SPECT is a reliable technique for the assessment of hepatocellular disease.

Topics: Aged; Female; Humans; Liver; Liver Diseases; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Patients with ascites are known to have complications such as pleural effusions and hernias. Special diagnostic procedures are occasionally necessary to determine the nature of the abnormality and to determine the corrective medico-surgical approach. The two cases described illustrate the usefulness of intraperitoneal as well as intrapleural injection of a radionuclide in diagnosing the leakage of ascitic fluid.

Topics: Adult; Ascites; Diaphragm; Female; Hernia, Ventral; Humans; Liver Diseases; Male; Middle Aged; Peritoneum; Pleura; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

Radionuclide liver-spleen imaging using Tc-99m SC may identify focal defects on routine examinations. Fatty infiltration has generally been described as a diffuse process in the liver that may be manifested on Tc-99m SC liver imaging as a nonhomogeneous pattern of radiopharmaceutical distribution or multiple small defects. This case demonstrates a focal defect on radionuclide imaging, simulating a space-occupying lesion that ultimately proved to be focal fatty infiltration. Although not an uncommon finding on CT, to the authors' knowledge this has not been reported in the nuclear medicine literature to date.

Topics: Adipose Tissue; Diagnosis, Differential; Female; Humans; Liver; Liver Diseases; Liver Neoplasms; Middle Aged; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A case of focal nodular hyperplasia of the liver is reported and its scintigraphic picture is presented. In the authors' experience and in accordance with available literary sources, Tc-99m-sulfur colloid scintigraphy is to be considered the crucial noninvasive examination approach revealing the pathologico-anatomical substrate of this asymptomatic hepatic lesion which may mimic severe focal disease of the liver.

Topics: Humans; Hyperplasia; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Focal nodular liver hyperplasia (FNLH) is a benign liver tumor developing mostly in young women but occurring sometimes in men. It is often confused with other liver diseases, particularly with hepatic cell adenoma. Differential diagnosis of these diseases is very important because their prognosis and therapy are quite different. The presence of functioning Kupffer cell determined by scintigraphy with 99mTc-colloid is a decisive factor in FNLH diagnosis. However colloid accumulation was not recorded in 30-50% of patients (according to literature data), and there were cold zones on scans. 99mTc-colloid uptake can be determined by single-photon emission computed tomography.

Topics: Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Hyperplasia; Imino Acids; Liver; Liver Diseases; Liver Neoplasms; Male; Organometallic Compounds; Organotechnetium Compounds; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Three cases of postpartum hepatic hemorrhage in the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELP) were diagnosed by Tc-99m sulfur colloid liver-spleen scanning. Two patients had follow-up scans. One showed rapid resolution of the hematoma on the repeat scan performed six days later, while the other showed delayed resolution on the repeat scan four weeks later. All patients received non-surgical supportive therapy with or without blood transfusion after delivery, and recovered well. Usefulness of radionuclide liver-spleen scanning in the diagnosis of peripartum hepatic hemorrhage and monitoring course of the disease is emphasized.

Topics: Adult; Female; Hemolysis; Hemorrhage; Humans; Liver; Liver Diseases; Pre-Eclampsia; Pregnancy; Puerperal Disorders; Radionuclide Imaging; Syndrome; Technetium Tc 99m Sulfur Colloid; Thrombocytopenia

Anterior dynamic imaging of the abdomen was performed in 870 patients using a large field-of-view (LFOV) gamma camera. Sequential images were obtained immediately after the injection of Tc-99m sulfur colloid (Tc-99m SC) in an antecubital vein for liver-spleen imaging and was followed by standard planar images. This provided additional information in 172 cases (20%), including such findings as determination of the lesion's vascularity in 76 (9%), visualization of abnormal portal blood flow in 53 (6%), and detection of abnormalities in the aorta, inferior vena cava, iliac vessels, or kidneys in 43 (5%) of these patients. This procedure is recommended in all patients undergoing liver-spleen imaging.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

SPECT of the spleen has been performed with 99Tcm-sulphur colloid in 53 patients, and SPECT of the liver has been performed in 57 patients. All patients had histologically proven liver disease and were classified by the degree of severity, Group A-severe, Group B-moderate, Group C-mild. The patients were further classified as cirrhotic and non-cirrhotic. Eight controls were also studied. There is positive though poor correlation between splenic volume and uptake (r2 = 0.55). Splenic volume and uptake are significantly different in Group A patients compared with all other groups (p less than 0.001). They are also significantly different in cirrhotics versus non-cirrhotics and cirrhotics versus controls (p less than 0.001). Splenic SPECT was unhelpful in distinguishing between moderate and mild liver disease. SPECT of the spleen is a time consuming technique but a useful adjunct to liver SPECT in patients with portal hypertension.

Topics: Electronic Data Processing; Female; Humans; Liver; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Models, Structural; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The presence of normal biliary flow was established in a patient with an indwelling hepatic catheter placed to drain an intrahepatic cyst cavity with the use of sequential hepatobiliary scintiscans. In the initial study drainage was demonstrated from the indwelling catheter; when the catheter was clamped, drainage was observed in the native biliary system. Serial biliary scintigraphy not only confirmed the patency of the hepatobiliary system, but served as a guide in the removal of the intrahepatic catheter.

Topics: Catheters, Indwelling; Cholestasis; Cysts; Drainage; Humans; Imino Acids; Liver Diseases; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

A total of 204 Tc-99m sulfur colloid hemodynamic studies of the liver taken at 5-second intervals were evaluated. The time when the gradually increasing activity in the liver becomes equal to the reducing activity in the heart pool is defined as the relative half clearance time (RHCT) of cardiac activity to the liver. The RHCT was measured in each scan and was correlated with clinical information, liver function tests, and static scan findings. Normal RHCT was established to be in the range of 40 +/- 20 seconds. This study indicates that the RHCT truly reflects the functional status of the hepatic blood flow as well as the phagocytic activity of the Kupffer cells of the liver when cardiac function is normal. A prolonged RHCT may indicate the presence of a parenchymal disease of the liver or cardiac failure with hepatic congestion, or both. The longer the RHCT, the more severe the pathologic condition of the liver, provided that cardiac function is normal.

Topics: Adult; Aged; Female; Hemodynamics; Humans; Kupffer Cells; Liver; Liver Circulation; Liver Diseases; Male; Middle Aged; Phagocytosis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

A comprehensive examination of patients with various liver diseases was performed using the methods of axial x-ray computerized tomography, ultrasound scanning compared to plane liver scintigraphy with 99m TC-colloid and a new method of one-photon emission computerized tomography (OECT). The sensitivity of the OECT, SG and USE methods was 92.7; 75.6 and 91.4% respectively, and specificity 88.0; 72.0 and 80.0%. The authors discussed the advantages of the OECT method and its diagnostic value in liver focal and diffuse lesions.

Topics: Evaluation Studies as Topic; False Negative Reactions; Humans; Liver; Liver Diseases; Radiography; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Ultrasonography

It is widely accepted that a palpable spleen in the adult population is always enlarged and pathological. The aim of this study was to assess the validity of this statement. As a routine, our protocol for liver-spleen studies includes liver pliability, which demonstrates the level of the hemidiaphragms at full inspiration and expiration, as well as splenic size and colloidal uptake. Sixteen hundred 99mTc sulphur colloid liver-spleen studies, which had been performed in our Department, were reviewed. In 21 patients, who had been referred with "splenomegaly for investigation", the scintigraphic splenic size was 13 cm posterior length or less. In this group, splenic palpability was confirmed by at least two clinicians. Follow-up did not reveal any evidence of splenic disease in 18 of the 21 patients. In a separate postmortem follow-up of 123 sequential liver-spleen scans, 100 patients were noted to have a scintigraphic splenic size of 13 cm posterior length or less. This was shown to be a reliable upper limit of normal because 98% of spleens in this group weighed 250 g or less and were normal at post-mortem examination. This study demonstrates that a palpable spleen is not necessarily enlarged or pathological.

Topics: Adult; Aged; Female; Humans; Liver; Liver Diseases; Male; Middle Aged; Palpation; Radionuclide Imaging; Spleen; Splenomegaly; Technetium Tc 99m Sulfur Colloid

The accuracy of scintigraphy in diagnosing hepatocellular carcinoma (HCC) at Boston City Hospital between January 1, 1978 and September 30, 1983 is retrospectively reviewed. A combined protocol using technetium-99m sulfur colloid (TsSC), gallium (Ga), and scintiangiography (STA) was employed in order to enhance diagnostic specificity. There were 14 cases of HCC, of which 10 were proven histologically. The others were diagnosed clinically and angiographically. With one exception, all patients who had triple tracer scintigraphy showed a specific pattern of findings: (1) cold defects with TcSC; (2) Ga-avid foci, and (3) increased vascular supply from hepatic arteries. One false-positive study and one false-negative study were originally reported, although in both cases, strict adherence to the three criteria above would have avoided diagnostic error. These results indicate that triple tracer scintigraphy may be an effective diagnostic test for HCC. The relative efficacy of scintigraphy, ultrasonography, and computerized tomography in diagnosing HCC is also discussed.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Diagnosis, Differential; Diagnostic Errors; Erythrocytes; Female; Gallium Radioisotopes; Hepatic Artery; Humans; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Sulfur Colloid

Techniques for improving image contrast in liver single-photon emission computed tomography (SPECT) are discussed. It is shown that by suitable choice of reconstruction method combined with subsequent image processing, image contrast can be improved without the generation of artefactual mottle. The use of this technique is illustrated with clinical data from a rotating gamma camera.

Topics: Electronic Data Processing; Humans; Liver; Liver Diseases; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The diagnosis of hepatic rupture in patients with pregnancy-induced hypertension (preeclampsia and eclampsia) is rarely made preoperatively. Diagnostic imaging can be utilized in some patients to confirm the preoperative diagnosis. Since hematoma formation precedes hepatic rupture, then, when diagnostic modalities such as sonography and computed tomography identify patients with hematomas, these patients are at risk of rupture, and should be hospitalized until the hematomas resolve.

Topics: Abdomen; Adolescent; Adult; Female; Hematoma; Humans; Liver Diseases; Pain; Pre-Eclampsia; Pregnancy; Rupture, Spontaneous; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Two patients with cystic disease of the liver have been studied with 99Tcm sulphur colloid and 99Tcm DISIDA scintigraphy and CT. One patient's cystic lesions are substantially enlarged as seen in 99Tcm sulphur colloid scintigrams performed at 10 year intervals. Another patient's scintigraphic studies performed at 5 year intervals demonstrated no significant progression in the size of the cysts in the liver. The 99Tcm DISIDA scintigram of each patient demonstrated no radiotracer filled-in in the cystic lesions (photon deficient areas on 99Tcm sulphur colloid scan). This finding may be used to differentiate cystic disease of the liver from hepatoma, in which usually DISIDA filled-in the defects seen on the 99Tcm sulphur colloid scintigram.

Topics: Aged; Cysts; Female; Humans; Imino Acids; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

Topics: Humans; Liver; Liver Diseases; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Humans; Hypersplenism; Liver; Liver Diseases; Liver Neoplasms; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

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

Topics: Adult; Biliary Tract; Diagnosis, Differential; Female; Humans; Hyperplasia; Liver; Liver Diseases; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

The ratio of splenic to hepatic activity in the posterior view of a Tc-99m SC liver-spleen scan has been used as an indicator of parenchymal disease. Analysis of liver-spleen scans from a series of patients acquired in both the supine and erect positions revealed that the spleen-liver ratio varied considerably with a change in the patient position. Qualitatively there was a shift of colloid from the liver to the spleen in five of 18 supine views and ten of 18 erect views. Quantitative analysis of 37 cases showed that the median erect spleen-liver ratio was 20% greater than the spleen-liver ratio observed in supine patients. Criteria for an abnormal spleen-liver ratio need to be established in each position.

Topics: Colloids; Humans; Liver; Liver Diseases; Posture; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The part played by 99Tc liver scintiscanning and laparoscopy, singly or sequentially, in the diagnosis of hepatic nodular disease was examined in a series of 316 patients. It was found that sequential employment of these two methods constituted a good diagnostic approach, since the relative sensitivity of the first could be added to the relative specificity of the second.

Topics: Cysts; Hepatitis; Humans; Laparoscopy; Liver Diseases; Liver Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Humans; Kidney; Liver Diseases; Male; Radionuclide Imaging; Serum Albumin; Sulfur; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

After the intravenous administration of Tc-99m sulfur colloid, there was found homogeneous lung, renal, and splenic uptake with absence of uptake by the liver and bone marrow of a nine-day-old female infant. More than 20 other doses were dispensed from the same Tc-99m sulfur colloid preparation with the expected biodistribution. A necropsy done two days later showed diffuse hepatic hemorrhagic necrosis without evidence of intravascular fibrin deposition in the lungs or kidneys. The underlying cause of the infant's disease was a Coxsackie B2 viral infection, based upon positive postmortem viral cultures of kidney and liver tissues and characteristic histopathologic lesions of the central nervous system and viscera. The altered biodistribution presumably reflected marked impairment of Kupffer cell function and an apparent increase in pulmonary macrophages.

Topics: Coxsackievirus Infections; Enterovirus B, Human; Female; Hemorrhage; Hepatitis, Viral, Human; Humans; Infant, Newborn; Infant, Newborn, Diseases; Liver; Liver Diseases; Necrosis; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Visualization of Ga-67 citrate in the kidneys at 48 hours and 72 hours post injection is usually interpreted as evidence of renal pathology. In reviewing approximately 200 consecutive patients referred for gallium scans, 40 patients who also underwent liver/spleen Tc-99m sulfur colloid (SC) studies within one month of the gallium study were identified. Fourteen of these patients showed advanced hepatocellular dysfunction on the Tc-99m SC liver/spleen images. Of these 14 patients, nine had persistent renal accumulation of gallium at 48 or 72 hours. Five of these nine patients had no evidence of primary renal disease by clinical or postmortem examination and subsequent clinical information indicated that two additional patients probably had no significant renal pathology. Therefore, bilateral symmetrically increased renal uptake of gallium in patients with advanced hepatocellular disease should not necessarily be interpreted as evidence of renal pathology.

Topics: Adult; Aged; Diagnosis, Differential; Gallium Radioisotopes; Humans; Kidney; Kidney Diseases; Liver; Liver Cirrhosis, Alcoholic; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Single-photon emission computed tomography (SPECT) is a new imaging method that offers the advantage of cross-sectional imaging and improved contrast resolution as compared with conventional planar imaging. Preliminary SPECT studies of the liver for detection of metastatic disease are very promising. However, these studies indicate some potential pitfalls in the interpretation of the normal liver SPECT images. Experience with 58 tomographic studies obtained with a General Electric 400T rotating gamma camera is presented, with special emphasis on the areas of potential misinterpretation and on recognition of the normal anatomy as seen by this technique.

Topics: Elementary Particles; Humans; Liver; Liver Diseases; Liver Neoplasms; Reference Values; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Tomography, X-Ray Computed; Ultrasonography

We compared liver scan interpretations based on anterior images obtained in the upright, prone, and supine positions. Receiver-operating-characteristic curves were generated for three well trained observers. Results showed that reading the three different views together was more accurate than the reading of any individual image. Furthermore, interpretations based on either the prone or upright view were superior to those using the supine view alone. The prone and upright views should be used more often in liver scanning.

Topics: Humans; Liver; Liver Diseases; Posture; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

False-positive radionuclide liver images can occur due to impingement on the liver by adjacent normal anatomic structures or adjacent pathologic masses or fluid collections. A patient with ascites in the anterior subphrenic space had an apparent "cold" lesion in the left lobe of the liver. Ultrasonography demonstrated a normal left lobe and localized the fluid collection.

Topics: Ascites; Diagnosis, Differential; False Positive Reactions; Humans; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Topics: Adult; Aged; Carcinoma, Hepatocellular; Colloids; Cysts; Female; Hemangioma; Humans; Liver Abscess; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The merit of concomitant hepatic imaging with Tc-99m-sulfur colloid (SC) and Tc-99m-HIDA was examined in 40 patients with abnormal liver function tests. The studies were performed sequentially within a 2 to 5 day interval with 5 mCi each of SC or HIDA. Routine static images in all cases, and dynamic studies with HIDA in 15 patients, were graded and compared with the liver function tests and clinical diagnoses. Of the 40 patients, the images with SC showed an abnormality in 22 while HIDA images were abnormal in 38. Thirteen of 21 patients with hepatocellular diseases showed an abnormality of the SC images, and 20 of the same 21 patients had abnormal HIDA images. Abnormal HIDA images were more closely related to abnormal liver function tests. These results suggest that alterations of hepatic function reflected by abnormal liver function tests are better demonstrated with hepatobiliary imaging agents than with reticuloendothelial imaging agents, while either type of imaging agents will detect focal anatomic lesions.

Topics: Humans; Imino Acids; Liver Diseases; Liver Function Tests; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

Topics: Aged; False Positive Reactions; Hepatomegaly; Humans; Liver Abscess; Liver Diseases; Male; Posture; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

A patient with acute parenchymal liver disease whose Tc-99m sulfur colloid (SC) liver/spleen scan showed a perisplenic halo in the posterior view (supine position) proved to have mild ascites at the time of autopsy. The signs of mild and massive ascites are briefly discussed.

Topics: Aged; Ascites; Humans; Liver; Liver Diseases; Male; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Humans; Liver Diseases; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Liver scanning with 99mCi 99Tc sulphur-colloid was practiced in 50 patients: 30 suffering from malignant tumors, 10 from hepatic cirrhosis and 10 from pyrexia of unknown origin. Liver radioactivity was recorded by a gamma-camera connected to a computer, 1 frame each 10 seconds for 15 minutes. The spectral analysis of the radioactivity counts taken in different region of interest, showed evidence of a periodic fluctuation, with a period value around 1 minute. Comparative ultrasonographic dynamic study showed evidence of the same phenomena in 16 examined patients. The period of pulsation was found different in each of the following groups: normal liver, cirrhotic, metastatic and infectious diseases.

Topics: Diagnosis, Differential; Humans; Liver Diseases; Liver Neoplasms; Neoplasm Metastasis; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Topics: Diagnosis, Differential; Humans; Liver Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Topics: Chronic Disease; Female; Humans; Liver Diseases; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A prospective investigation comparing Tc-99m-PIPIDA with Tc-99m-sulfur colloid in the detection of defects of the liver was carried out in 30 volunteers. By acquiring images of 1 million counts from 5-10 minutes postinjection, high quality hepatic images could be obtained with PIPIDA. Separate interpretations by three nuclear physicians yielded similar results between paired PIPIDA and sulfur colloid studies (KAV = 0.95 +/- .09, P less than 0.001). Early multiview imaging of the liver in the course of hepatobiliary evaluation with PIPIDA may yield valuable information relative to the presence of lesions.

Topics: Humans; Imino Acids; Liver; Liver Diseases; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Liver subtraction scans using 99Tcm sulphur coloid and 75Se-selenomethionine were carried out in 58 patients with suspected hepatoma. Of the 18 patients with hepatoma proven by histology, 16 showed selective concentration of selenomethionine in the tumour, giving a true positive rate of 89%. Of the 40 patients who did not have hepatoma, 32 scans showed no evidence of selective concentration of selenomethionine, giving a true negative rate of 80%. The false positive rate was 8% in non-cirrhotic patients with focal disease, but 55% in patients with cirrhosis. It is concluded that combined scanning with this technique is useful in non-cirrhotic patients in distinguishing hepatoma from other causes of focal disease, but that the technique is not useful and frequently misleading in patients with cirrhosis.

Topics: Carcinoma, Hepatocellular; Diagnosis, Differential; False Positive Reactions; Humans; Liver Diseases; Liver Neoplasms; Radioisotopes; Radionuclide Imaging; Selenium; Selenomethionine; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Imaging of diffuse liver disease is traditionally done with Tc-99m-sulfur colloid. The advent of Tc-99m-labeled hepatobiliary agents led the authors to reevaluate the role of Tc-99m-sulfur colloid. A total of 95 paired Tc-99m-diethyl-IDA and Tc-99m-sulfur colloid studies were performed in 61 patients (60 paired studies in liver transplant patients and 35 paired studies patients who had not received liver transplants). The following parameters were visually graded on a five-point scale: Tc-99m-diethyl-IDA clearance and time of appearance of appearance of intestinal activity; and Tc-99m-sulfur colloid liver size, bone marrow activity, splenic size, splenic activity, lung activity. Total serum bilirubin levels were used as the standard measure of liver function. The Tc-99m-diethyl-IDA parameters correlated more highly with total serum bilirubin than did the Tc-99m-sulfur colloid parameters in both the transplant and nontransplant groups. In conclusion, Tc-99m-diethyl-IDA appears to be the preferred radiopharmaceutical for evaluation of hepatocellular function, although both agents may be needed in certain clinical situations.

Topics: Bilirubin; Bone Marrow; Humans; Imino Acids; Liver; Liver Diseases; Liver Transplantation; Lung; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Child; Colloids; Female; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; 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