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

Topics: Adult; Carcinoma, Hepatocellular; Diagnostic Imaging; Female; Humans; Liver; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

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

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 use of surgically implanted chemoinfusion pumps for the treatment of hepatic metastases from colorectal carcinoma can be complicated by intra- or extrahepatic misperfusion. This may result in suboptimal tumor exposure to the chemotherapeutic agent and injury to other gastrointestinal organs. Misperfusion can be managed by selective arterial transcatheter embolization.. Between 1989 and 1996, 16 patients with liver metastases from colorectal carcinoma and with hepatic artery chemoinfusion pump misperfusion were treated using transcatheter coil embolization. Six female and 10 male patients (age range, 34-84 years; median, 51.5 years) were identified by retrospective review of the records of the Department of Interventional Radiology. After pump placement, abnormal liver perfusion scan or methylene blue endoscopy study results prompted angiography with coil embolization. After embolization, the imaging studies were repeated and patients were monitored in the Oncology Clinic.. Eight patients exhibited intrahepatic misperfusion (group 1) and eight extrahepatic misperfusion (group 2). Coil embolization was immediately successful in 100% of patients in group 1, with restoration of normal hepatic perfusion, and in 75% in group 2. There were no immediate procedure-related complications. Follow-up periods ranged from 1 to 23 months (median, 13.5 months). Embolization was unsuccessful for two patients (in group 2), who tolerated a modified chemotherapeutic regimen, with follow-up periods of 18.5 and 22 months.. Transcatheter coil embolization is the therapy of choice for the management of hepatic artery chemoinfusion pump misperfusion. It is rapid, effective, and well tolerated by patients and obviates the need for additional surgical intervention.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Embolization, Therapeutic; Female; Follow-Up Studies; Hepatic Artery; Humans; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Treatment Outcome

Topics: Embolization, Therapeutic; Female; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Embolization, Therapeutic; Female; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Planning hepatic (90)Y radioembolization activity requires balancing toxicity with efficacy. We developed a dual-tracer SPECT fusion imaging protocol that merges data on radioactivity distribution with physiologic liver mapping.. Twenty-five patients with colorectal carcinoma and bilobar liver metastases received whole-liver radioembolization with resin microspheres prescribed as per convention (mean administered activity, 1.69 GBq). As part of standard treatment planning, all patients underwent SPECT imaging after intraarterial injection of 37 MBq of (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) to simulate subsequent (90)Y distribution. Immediately afterward, patients received 185 MBq of labeled sulfur colloid ((99m)Tc-SC) intravenously as a biomarker for normal hepatic reticuloendothelial function and SPECT was repeated. The SPECT images were coregistered and fused. A region-based method was used to predict the (90)Y radiation absorbed dose to functional liver tissue (DFL) by calculation of (99m)Tc-MAA activity in regions with (99m)Tc-SC uptake. Similarly, the absorbed dose to tumor (DT) was predicted by calculation of (99m)Tc-MAA activity in voxels without (99m)Tc-SC uptake. Laboratory data and radiographic response were measured for 3 mo, and the survival of patients was recorded. SPECT-based DT and DFL were correlated with parameters of toxicity and efficacy.. Toxicity, as measured by increase in serum liver enzymes, correlated significantly with SPECT-based calculation of DFL at all time points (P < 0.05) (mean DFL, 27.9 Gy). Broad biochemical toxicity (>50% increase in all liver enzymes) occurred at a DFL of 24.5 Gy and above. In addition, in uni- and multivariate analysis, SPECT-based calculation of DT (mean DT, 44.2 Gy) correlated with radiographic response (P < 0.001), decrease in serum carcinoembryonic antigen (P < 0.05), and overall survival (P < 0.01). The cutoff value of DT for prediction of 1-y survival was 55 Gy (area under the receiver-operating-characteristic curve = 0.86; P < 0.01). Patients who received a DT of more than 55 Gy had a median survival of 32.8 mo, compared with 7.2 mo in patients who received less (P < 0.05).. Dual-tracer (99m)Tc-MAA-(99m)Tc-SC fusion SPECT offers a physiology-based imaging tool with significant prognostic power that may lead to improved personalized activity planning.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Embolization, Therapeutic; Female; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Prognosis; Radiometry; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Yttrium Radioisotopes

We previously identified tumor-reactive lymphocytes in the first lymph nodes that drain the primary tumor. In this study, we performed lymphatic mapping to investigate the possibility of finding the first lymph nodes that drain metastases, and of learning whether these lymph nodes contained tumor-reactive lymphocytes suitable for adoptive immunotherapy.. Nineteen patients were studied. The primary tumor site was colorectal cancer in seven patients, malignant melanoma in four, ovarian cancer and breast cancer in two, and one each with pancreatic cancer, cholangiocarcinoma, leiomyosarcoma, and squamous cellular cancer of the tongue. By injection of Patent blue dye or radioactive tracers around the metastases, we identified draining lymph nodes from liver metastases (n = 9), intra-abdominal local recurrences (n = 3), and regional lymph node metastases (n = 7). In six patients, a preoperative lymphoscintigraphy was performed.. We located the first draining lymph node or nodes from metastases or local recurrences; we named them "metinel nodes." Lymphocytes from the metinel nodes proliferated, showed clonal expansion, and produced interferon gamma (via in vitro expansions on stimulation with tumor homogenate) and interleukins, all of which demonstrate the characteristics of tumor-reactive lymphocytes. Eight of the nineteen patients received immunotherapy on the basis of tumor-reactive T cells derived from the metinel nodes.. We demonstrate that it is possible to locate the first lymph nodes draining subcutaneous, lymphatic, and visceral metastases, the so-called metinel nodes. Metinel node-derived lymphocytes may be used to treat disseminated solid cancer, and clinical trials should evaluate the effect of such treatment.

Topics: Adult; Aged; Cells, Cultured; Female; Humans; Immunoenzyme Techniques; Immunotherapy; Interferon-gamma; Liver Neoplasms; Lymph Nodes; Lymphatic Metastasis; Lymphocytes, Tumor-Infiltrating; Male; Middle Aged; Neoplasm Recurrence, Local; Preoperative Care; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Rosaniline Dyes; Technetium Tc 99m Sulfur Colloid

Topics: Child; Hepatectomy; Hepatoblastoma; Humans; Liver; Liver Neoplasms; Liver Regeneration; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Humans; Liver Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Hemangioma; Humans; Liver Neoplasms; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 1979-1996.. University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.. Retrospective and follow-up analysis.. Medical records of patients with histologically proven hepatocellular adenoma were analysed with respect to complaints, diagnostic approach and therapeutical management. Follow-up took place at the outpatient department where history-taking, physical examination, ultrasonography and hepatitis B and C serology tests were performed.. In the period 1979-1996, 20 patients with hepatocellular adenoma were treated. Eight patients (mean tumour size 3.2 cm (1.5-5)) were treated conservatively, 12 (mean tumour size 8.1 cm (6-10)) underwent hepatic resection; four because of rupture of the tumour. Serum liver enzyme values did not contribute to the diagnosis. Of the lesions 78% were diagnosed correctly by ultrasonography and 71% by computer tomography. Median follow-up of the patients treated operatively was 73 months (1-204). One patient died three years after an incomplete resection of a hepatocellular adenoma, because of a hepatocellular carcinoma. Ultrasonography did not demonstrate any recurrent tumours in the other patients. In the group of patients conservatively treated (median follow-up 39 months (24-72)) two patients died because of a hepatocellular carcinoma. Ultrasonography demonstrated stable tumour diameters in three patients and regression in three others.. Based on the literature and the presented experience surgical treatment is the treatment of choice in patients with large (> or = 5 cm diameter) hepatocellular adenomas because of the risk of malignant transformation and rupture of the tumour. With smaller tumours (< 5 cm) a conservative treatment may suffice in hepatitis virus negative patients, including withdrawal of oral contraceptives followed by thorough ultrasound follow-up of tumour size. In case of tumour growth or complaints a resection of the tumour is indicated.

Topics: Adenoma, Liver Cell; Adult; Biopsy, Needle; Carcinoma, Hepatocellular; Cause of Death; Diagnosis, Differential; Disease-Free Survival; Female; Follow-Up Studies; Humans; Liver; Liver Neoplasms; Male; Retrospective Studies; Rupture, Spontaneous; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Treatment Outcome; Ultrasonography

Cavernous hemangioma is the most common benign tumor of the liver, the organ in which these lesions are most often present. We report on 28 patients who underwent 99mTc-labeled red cell scintigraphy after ultrasound or computerized tomography images suggesting the existence of one or more hepatic angiomas. In 16 patients (57.1%), an accumulation of red blood cells was considered to indicate the existence of hemangiomas. On the basis of subsequent clinical follow-up, ultrasound studies, and in one case laparotomy, all were eventually confirmed to be hemangiomas. The specificity as 100%. In the remaining 12 patients (42.9%), red cell uptake was not observed and the findings were considered negative; in this group, there were 10 true negatives and 2 false negatives in which scintigraphy failed to detect the existing angiomas due to their small size and deep location. The sensitivity was 88.8%. On the basis of the results, it is concluded that labeled red cell scintigraphy is a highly sensitive and specific method for the diagnosis of cavernous hemangioma of the liver. It should be considered the method of choice when this lesion is suspected, thus avoiding the use of more invasive diagnostic procedures such as laparoscopy which, in our study proved to be unnecessary.

Topics: Adult; Aged; Erythrocytes; Female; Gamma Cameras; Hemangioma, Cavernous; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid; Time Factors

Hepatoblastoma is a primary liver neoplasm in which prompt diagnosis and resection are critical to long-term survival. Nuclear scintigraphy plays an important role in the characterization of hepatic masses. The authors present an unusual case of hepatoblastoma in a 12-year-old boy in whom Ga-67 scintigraphy and serum alpha-fetoprotein were negative. Positive Tl-201 scintigraphy pointed toward the true malignant nature of the mass and should be considered in the investigation of hepatic masses in childhood.

Topics: alpha-Fetoproteins; Biomarkers, Tumor; Child; Gallium Radioisotopes; Hepatoblastoma; Humans; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Thallium Radioisotopes

An uncommon case of hepatocellular adenoma is presented. In this case, the tumor was Tc-99m SC avid rather than the typical pattern of no uptake. Liver scintigraphy was able to demonstrate that the tumor originated from the liver correlating with ultrasound and computed tomography. Background information on hepatocellular adenomas, a differential diagnosis, and a logical approach to similar liver lesions is discussed.

Topics: Adenoma, Liver Cell; Adult; Female; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

This is a case report of a patient with an initial diagnosis of chronic pancreatitis who actually had metastatic carcinoid tumor. His symptoms of abdominal pain, weight loss, and diarrhea were manifestations of the large tumor bulk within the liver as well as carcinoid syndrome. Although abdominal CT scans showed multiple liver lesions, the primary lesion was not identified by conventional imaging studies. However, the mid-gut primary lesion was visualized on in-111 labeled octreotide scintigraphy; where the liver lesions were better delineated and seen to be separate from the normal pancreas when the Tc-99m sulfur colloid images were compared to the octreotide images.

Topics: Abdominal Pain; Adult; Antineoplastic Agents, Hormonal; Carcinoid Tumor; Chronic Disease; Diagnosis, Differential; Diarrhea; Humans; Indium Radioisotopes; Intestinal Neoplasms; Liver Neoplasms; Male; Malignant Carcinoid Syndrome; Octreotide; Pancreatitis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Weight Loss

Tl-201 chloride has been used to image viable tumors in various sites of the body. There has been limited use of Tl-201 below the diaphragm because of normal uptake in the liver, spleen, kidneys, and intestines. The use of sequential Tl-201 and Tc-99m sulfur colloid in the detection and characterization of suspected hepatocellular carcinoma (HCC) was prospectively evaluated.. Four patients with indeterminate liver nodules on radiologic imaging studies were studied with sequential Tl-201 and sulfur colloid liver scans on a triple-headed gamma camera with planar and SPECT acquisition. All patients had subsequent pathologic correlation.. There were three focal nodular HCC lesions and one case of multicentric HCC, size varying between 1.9 cm and greater than 4.0 cm (multicentric HCC). In all lesions, Tl-201 SPECT images showed abnormal increased uptake at sites of HCC, which corresponded to areas of photopenia on sulfur colloid. Computed tomography detected a lesion in two of four patients, whereas US was positive in all patients. However, US was specific for tumor in only one patient and CT was not specific in any patient.. We believe that in patients with suspected HCC, Tl-201 SPECT imaging will have an important role in the detection and characterization of HCC, especially in the cirrhotic patient. Planar Tl-201 hepatic images will usually be normal, except in large lesions, and high-resolution SPECT technique is essential in successful liver tumor imaging.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Child; Gamma Cameras; Humans; Intestines; Kidney; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Prospective Studies; Radiopharmaceuticals; Spleen; Technetium Tc 99m Sulfur Colloid; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography

Topics: Humans; Hyperplasia; Liver; Liver Neoplasms; Pylorus; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Erythrocytes; Hemangioma; Humans; Liver Neoplasms; Male; Neoplasms, Multiple Primary; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Imaging with I-131 MIBG has proved useful for the detection of pheochromocytoma, neuroblastoma, and other neoplasms of neural crest origin. The authors present a case of a patient who was initially diagnosed as having follicular carcinoma of the thyroid in which I-131 MIBG played a key role in leading to the diagnosis of medullary carcinoma of the thyroid. Local and distant metastases were detected using I-131 MIBG imaging. Uptake of I-131 MIBG by medullary carcinoma of the thyroid has both diagnostic and therapeutic implications.

Topics: 3-Iodobenzylguanidine; Adenocarcinoma, Follicular; Antineoplastic Agents; Carcinoma, Medullary; Humans; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Thyroid Neoplasms

Gallium-67 is routinely used for follow-up of patients with malignant melanoma. However, its nonspecificity for melanoma and its high rate of false-positive results have always been a matter of concern. The authors describe a patient who encountered serious problems with the use of gallium. Because gallium is taken up well by the liver and by melanoma, results of gallium scintigraphy of the liver may appear normal even if there is metastatic disease. In this patient, results of gallium scintigraphy of the liver were negative for metastasis but revealed extrahepatic foci detected by the monoclonal antibody. Computed tomography showed areas of attenuation, revealing only a few intrahepatic tumors and no extrahepatic disease. Tc-99m SC revealed intrahepatic metastases, but no extra-hepatic metastases were seen. A monoclonal antibody (ZME-018) scintigram did reveal hepatic metastases along with probable small, extrahepatic, metastatic foci. Overall hepatic uptake of the monoclonal antibody was relatively low. An image subtraction algorithm was devised whereby the sulfur colloid image was subtracted from the gallium scintigram. The resultant image revealed both the intrahepatic and extrahepatic metastases seen on the ZME-018 images. It is likely that in the past many hepatic metastases have been missed because Tc-99m SC images have not been routinely used as part of melanoma management protocols. The uptake of the ZME-018 by the tumor was significantly higher than that of the normal liver, suggesting that ZME-018 labeled with the appropriate emitter may be an effective specific therapeutic tool in selected patients.

Topics: Adult; Algorithms; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Indium Radioisotopes; Liver Neoplasms; Melanoma; Radioimmunodetection; Skin Neoplasms; Subtraction Technique; Technetium Tc 99m Sulfur Colloid

Although benign vascular tumors of the liver are extremely common (hemangioma is the most common), malignant vascular tumors of the liver are very rare. In the adult, these tumors are angiosarcoma, epithelioid hemangioendothelioma, and Kaposi sarcoma. All hepatic malignant vascular tumors share histologic characteristics, grow around and into vessels, and are grossly multifocal. They may be misdiagnosed histologically, particularly if only a biopsy sample is available. Although imaging findings are often non-specific, some features are suggestive or even characteristic of these neoplasms. Such features include previous exposure to thorium dioxide (Thorotrast) in cases of angiosarcoma, coalescence of multiple nodules into large peripheral masses in epithelioid hemangioendothelioma, and association between acquired immunodeficiency syndrome and cutaneous involvement in Kaposi sarcoma. Because hepatic malignant vascular tumors are often multiple, the main differential diagnosis is metastatic disease. There is no effective treatment for these tumors, and although survival time is variable, the prognosis is generally unfavorable.

Topics: Hemangioendothelioma, Epithelioid; Hemangiosarcoma; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasms, Vascular Tissue; Sarcoma, Kaposi; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

The therapeutic potential of 131I-Lipiodol was investigated in 8 patients with cholangiocarcinoma (CCA) and 15 patients with hepatocellular carcinoma (HCC). Patients received one or two doses of 131I-Lipiodol via hepatic arterial injection. The mean total administered activity was 668 (SD 325) MBq in CCA and 953 (SD 477) MBq in HCC. One patient with CCA retained 131I-Lipiodol. The cumulative radiation dose was 9.6 Gy to tumour, 6.4 Gy to liver and 1.5 Gy to lung. The patient remained asymptomatic with no evidence of tumour 30 months from the start of treatment, whereas the remaining 7 patients exhibited tumour progression. The mean survival in CCA was 11.6 (SD 14.5) months. All 15 patients with HCC retained 131I with tumour: liver ratios of up to 30:1. The mean cumulative radiation dose was 34.7 (SD 32.4) Gy to tumour, 3.3 (SD 1.5) Gy to liver and 4.4 (SD 2.3) Gy to lung. The mean dose per administered activity was 3.8 (SD 4.1) cGy/MBq. Partial response (reduction in tumour size > 50%) was observed in 6 patients (40%). The mean survival was 7.1 (SD 6.0) months. 131I-Lipiodol can deliver highly selective internal irradiation to foci of HCC with evidence of objective response and may be the treatment of choice for patients with cirrhosis and a small tumour.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cholangiocarcinoma; Female; Follow-Up Studies; Gamma Cameras; Humans; Iodine Radioisotopes; Iodized Oil; Liver Neoplasms; Male; Middle Aged; Pilot Projects; Radionuclide Imaging; Remission Induction; Survival Rate; Technetium Tc 99m Sulfur Colloid; Treatment Outcome

The aim of the study was the estimation of diagnostic importance of the hepatic blood pool tomoscintigraphy (SPECT) and planar scintigraphy in patients investigated under suspicion of the liver hemangioma. In the diagnostic procedure the correlation between radiocolloidal scintigraphy, blood pool planar scintigraphy (early and late) and SPECT was made. Sixty-seven patients with focal lesions in the liver were investigated. The blood pool scintigraphy was made after application of traser dose of 99mTc and equilibration of tagged red blood cells in circulation. The planar scintigraphy was made 20 min after the red cells tagging and again 2 hours later (early and late scintigrams). SPECT was also applied to make the diagnostic procedure more accurate. From 31 hemangiomas detected by SPECT only 19.4% were clearly visible by planar scintigraphy. The diagnostic of very small hemangiomas is enabled by SPECT too.

Topics: Adult; Aged; Aged, 80 and over; Erythrocytes; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

A theoretical description of the relationship between the count rate detected in the cardiac region of interest and the arterial organ input function in dynamic scintigraphy is presented. It is shown that, provided the time-activity curve for the heart is corrected for extra-cardiac and unlabelled activity, it is proportional to the arterial organ input over both the first-pass and equilibrium phases of the passage of an intravenously injected radiopharmaceutical. A practical example demonstrating the value and validity of correcting the cardiac curve in dynamic radio colloid scintigraphy is described. Estimates of the colloid clearance rate to reticuloendothelial sites using the cardiac curve without correction were significantly lower (mean 0.085/min) than those derived from the liver uptake curve (mean 0.213/min). However, corrected cardiac curve clearance rates (mean 0.225/min) were not significantly different from the liver ones. Also, the corrected cardiac curve clearance values correlated linearly with liver curve values (correlation coefficient 0.89, standard error of the estimate 0.021/min), whereas the uncorrected values showed no significant correlation. Thus, correction of the cardiac curve gave clearance rate values that were both more accurate and more precise than those obtained without correction.

Topics: Heart; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Artifacts; Female; Funnel Chest; Humans; Liver Neoplasms; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

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

Hepatoblastoma is a primary liver neoplasm in which prompt diagnosis and resection are critical to long-term survival. Liver scintigraphy using Tc-99m sulfur colloid and Tc-99m iminodiacetic acid (IDA) derivatives has been used in the evaluation of hepatic masses. Most space-occupying lesions of the liver appear as photopenic regions following either Tc-99m SC or IDA agents. Two exceptions have been reported. Focal nodular hyperplasia (FNH) has been shown to have variable colloid uptake, which is dependent upon the number of Kupffer cells per given volume. Many patients with FNH will demonstrate activity within the FNH to be greater or equal to the normal liver. In addition, two cases of hepatoblastoma have been reported to show colloid activity within the tumor, and in one patient slight uptake of Tc-99m IDA was noted in the tumor 15 minutes postinjection. The current case demonstrates a hepatoblastoma in which the scintigraphic findings with Tc-99m SC and Tc-99m IDA were similar to those reported, with retention of IDA far greater than the previously reported case.

Topics: Carcinoma, Hepatocellular; Diagnosis, Differential; Humans; Hyperplasia; Imino Acids; Infant; Liver; Liver Neoplasms; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A new approach to simultaneous spatial resolution and attenuation correction in SPECT imaging is presented. Before these corrections, scatter is removed on the projections. This removal is performed by spectral constrained factor analysis. The innovation reported here is the use of the different impulse responses of the system, according to the source-detector distance, and their integration in a generalized version of the Chang attenuation correction method. This novel algorithm is evaluated on computed and physical phantoms. In the computer-simulated phantom, the count rates after full-processing are very close to the initial values. In the physical phantom, the contrast is increased by 1.8 after full processing. The activity profiles drawn both on raw projections and reconstructed slices demonstrate the effectiveness of the algorithm for the restoration of spatial resolution. Furthermore, the method improves the quality of the images greatly. A clinical study is also presented. When the whole procedure is applied, the resulting slice matches the corresponding computed tomographic scan very well, which is not the case with the usual back-projected images. The process is fully automatic and the computing time performance allows its daily use for single photon emission tomographic examinations.

Topics: Algorithms; Computer Simulation; Factor Analysis, Statistical; Humans; Liver Neoplasms; Models, Structural; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Humans; Liver Circulation; Liver Neoplasms; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds

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

Clinically significant lesions originating within a Riedel's lobe are extremely rare. Characteristic findings from a Tc-99m SC liver-spleen scan of metastatic breast carcinoma arising in a Riedel's lobe are described.

Topics: Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Liver; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

We reviewed the results of radionuclide liver imaging in 70 patients newly referred for evaluation and treatment of persistent gestational trophoblastic tumors. Some 58 patients (83%) had abnormal liver scans but no focal defects and no discernible hepatic malignancy. These diffusely abnormal scans may reflect chemotherapeutic and/or hormonal effects on the liver and should not be interpreted as indicative of metastases.

Topics: Female; Humans; Liver; Liver Neoplasms; Pregnancy; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Trophoblastic Neoplasms; Uterine Neoplasms

Topics: Carcinoma, Hepatocellular; Female; Gallium Radioisotopes; Ganglia, Sympathetic; Humans; Liver; Liver Neoplasms; Middle Aged; Pheochromocytoma; Radionuclide Imaging; Retroperitoneal Neoplasms; Technetium Tc 99m Sulfur Colloid

Data from dynamic radiocolloid liver scintigraphy (DLS) have been analysed to calculate three indices of relative arterial to total hepatic perfusion. Ninety subjects have been studied, comprising 21 normals, 62 patients with metastatic liver disease and 7 patients with cirrhosis. Correlation coefficients above 0.81 were found in all patient groups between an index based on rates of liver uptake (the hepatic perfusion index, HPI) and a method based on quantitative liver uptake (the mesenteric fraction, MF). A further method employing the spleen to model arterial inflow (hepatic arterial ratio, HAR) had less agreement with both HPI and MF, with correlation coefficients below 0.76. Posterior images have previously been used to calculate HAR, and greater errors are expected in HAR from the anterior images acquired in this study. Receiver operating characteristic analysis showed that the diagnostic performance of HPI and MF indices in metastatic disease were not significantly different. For anterior image data analysis both HPI and MF were superior to HAR.

Topics: Humans; Liver; Liver Circulation; Liver Cirrhosis; Liver Neoplasms; Radionuclide Imaging; Reference Values; ROC Curve; Technetium Tc 99m Sulfur Colloid

An automated volume determination program using SPECT imaging with Tc-99m has been validated by both phantom and patient studies. Its use for monitoring change of function of the liver and change in tumor mass during different therapy regimes has been assessed. The technique is not restricted to the estimation of the hepatic functioning tissues; it therefore has many potential clinical implementations for volume determination in other organs.

Topics: Humans; Liver; Liver Neoplasms; Models, Structural; Monitoring, Physiologic; Software; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Giant hemangiomas of the liver are clinically distinct from smaller and more innocent hemangiomas as they are more prone to complications. On imaging with ultrasound, they can also be readily confused with hepatoma, metastatic disease, or focal nodular hyperplasia. Nine giant hemangiomas (maximal diameter greater than 8 cm) were studied by scintigraphy and ultrasound. In all instances, the fill-in of the lesion on [99mTc]RBC scintigraphy indicated the diagnosis of hemangioma, adding specificity to the screening sonographic study. The pattern of fill-in on scintigraphy also appeared to be size dependent with lesions less than 11 cm in diameter equilibrating uniformly, while larger abnormalities intensified in centripetal fashion.

Topics: Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Ultrasonography

The clinical records of 94 patients with regionally advanced melanoma (nodal disease or regional satellites) were reviewed to determine the value of preoperative bone and liver imaging. Of 68 bone scans obtained, none were suggestive of metastases. of 97 liver imaging studies (computed tomography, scintiscan, or sonography) in 88 patients, only two were found to have demonstrable metastases. Liver enzyme elevation was present in both of these patients. Bone and liver imaging in the absence of signs or symptoms of dissemination by history, physical examination, chest x-ray, and enzyme determination for regionally advanced melanoma appears to be of little value unless the patient is involved in a protocol study.

Topics: Alkaline Phosphatase; Bone Neoplasms; Female; Humans; Liver Neoplasms; Male; Melanoma; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Technetium-99m planar sulfur colloid scintigraphy, red blood cell imaging and ultrasonography were performed in eighteen patients of hepatic hemangioma to evaluate their diagnostic utility. Radiocolloid scans detected fourteen hemangiomas in 12 patients as focal hepatic defects but missed 9 lesions smaller than 2.5 cm in the other 6 patients, accounting for a 61% sensitivity. All 23 lesions were avascular or normovascular on radionuclide flow study. Serial planar red blood cell scintigraphy showed characteristic gradually increasing focal isotopic accumulation in the 14 hemangiomas which had identifiable cold areas on the radiocolloid study. One of 6 patients with normal radiocolloid scan also showed the typical increasing blood pool pattern of hemangioma, five had normal planar scans till 1 1/2 hours. SPECT red blood cell imaging in these 5 patients detected an additional seven hemangiomas. All 7 lesions were smaller than 2.5 cm. One 1.5 cm hemangioma was missed on both planar and SPECT red blood cell imaging. Region of interest ratios in SPECT transaxial images confirmed gradually increasing concentration of labeled red blood cells in the lesions. Ultrasonography detected 22 of the 23 hemangiomas. Ten were hyperechoic, average size 2.25 cm. Twelve were of mixed pattern, generally larger, average size 7.2 cm. Sonography is useful in the detection of hepatic hemangiomas as a focal mass lesion, but the variable sonographic appearance precludes a definite pathological diagnosis. Technetium-99m red blood cell imaging appears a sensitive technique in detection of hepatic hemangioma, with SPECT being especially useful in locating smaller lesions. The addition of useful in locating smaller lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver Neoplasms; Male; Middle Aged; Radiography; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Two patients with bilobar liver metastases were characterized by dual arterial blood supply to the liver. Treatment of both patients by the administration of chemotherapy, selectively via the arterial branches supplying the respective hepatic lobes bearing the metastases, resulted in differential tumor regression/progression. Thus, while the metastases borne by the arterially infused lobe regressed, the counterpart in the other (systemically infused) lobe showed marked progression. This phenomenon lends strong support to the notion that arterial infusion of chemotherapy in cases of regionally predominant (or confined) neoplastic disease, i.e., in the liver, is superior to the intravenous administration of similar drugs.

Topics: Adult; Aged; Antineoplastic Agents; Cisplatin; Female; Hepatic Artery; Humans; Injections, Intra-Arterial; Injections, Intravenous; Liver; Liver Neoplasms; Male; Melanoma; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors

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

Dual tracer scintigraphy (DTS) (technetium 99m [99mTc] sulfur colloid and gallium 67 citrate [67 gallium citrate]) of the liver and computer subtraction studies (SS) were performed in 26 patients subsequently proven to have hepatocellular carcinoma (HCC) and 32 patients with cirrhosis and focal defects on the colloid scan, with no evidence for HCC after a complete evaluation and a 2-year follow-up period. Both DTS and SS had a sensitivity of 96% and a specificity of 90.6% for HCC. There were three false positive cases (9.4%), two of which were occult abscesses. The predictive value of a positive test was 89% and that of a negative test was 97%. The smallest tumor detected measured 2 cm in diameter and was only visualized with the SS. In the clinical setting, when HCC is suspected (a situation in which tumors are usually larger than 2 cm and the pretest probability of disease is between 20% and 60%) the DTS and SS is an excellent test for the diagnosis or exclusion of HCC. It does not appear to have a role in screening programs.

Topics: Carcinoma, Hepatocellular; False Negative Reactions; False Positive Reactions; Gallium Radioisotopes; Humans; Liver Neoplasms; Probability; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Results from ultrasonography, computed tomography (CT), scintigraphy, hepatic angiography, and magnetic resonance (MR) imaging were analyzed for five patients with surgically proved fibrolamellar hepatocellular carcinoma (FL-HCC)--a variant of hepatocellular carcinoma (HCC) that usually occurs in younger patients and has an improved prognosis and chance for curative resection. The radiologic findings were generally inconclusive for a differential diagnosis because the appearance of the lesions on the various imaging studies closely simulated that of either focal nodular hyperplasia, HCC, or metastases. CT and technetium-99m sulfur colloid scintigraphy were the most effective techniques for the workup of these lesions, but because they do not allow a definitive diagnosis, open biopsy is recommended for most lesions simulating focal nodular hyperplasia and HCC in younger patients. Although the current specificity of MR imaging in diagnosing liver lesions is low, further experience may permit more specific characterization of these lesions.

Topics: Adult; Angiography; Biopsy; Carcinoma, Hepatocellular; Female; Hepatectomy; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Twenty-one patients with hepatocellular carcinoma who had gallium scans were retrospectively reviewed. Four of them demonstrated iso-intense gallium uptake compared to the adjacent liver parenchyma. The importance is therefore emphasized of using radiocolloid scan with tracer angiogram performed at the same time in order to avoid the potential diagnostic pitfall of not recognizing the tumor on gallium scan alone.

Topics: Aged; Carcinoma, Hepatocellular; Drug Evaluation; Gallium; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Aggregated Albumin; 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

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 a retrospective study the diagnostic validity of sonography (US), computer-tomography (CT), scintigraphy (SC) and serum alkaline phosphatase (AP) in the detection of liver metastases was evaluated in 929 patients with malignant tumors: ovary (n = 367), mamma (n = 189), endometrium (n = 181), cervix (n = 162), fallopian tube (n = 10), vulva (n = 20). Definitive diagnosis was confirmed by autopsy (n = 51), surgical intervention (n = 297) or follow-up (n = 581). Specificity, sensitivity and overall accuracy of the different methods in the indication of liver metastasis were as follows: CT (n = 58) 81%, 98%, 93%, US (n = 929) 70%, 94%, 90%, SC (n = 512) 66%, 85%, 81%, AP (n = 325) 68%, 93%, 87%. In the last examination period, US and CT reached comparable results. In view of efficiency, AP and US would appear suitable for routine control in gynecological malignancies.

Topics: Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Diagnostic Imaging; Female; Genital Neoplasms, Female; Humans; Liver Function Tests; Liver Neoplasms; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

The comparative value of staging the extent of colorectal liver metastases by isotope, ultrasound and CT imaging has been assessed in 20 patients considered for inclusion into a randomized trial. Metastases were identified in all patients by CT, but failed in 4 by isotope and 2 by ultrasound scanning. There was often a discrepancy of 25% in estimating tumour replacement between the different modalities and surgical evaluation. As the extent of tumour is an important prognostic factor, initial evaluation should incorporate all three imaging techniques. Relative regional blood flow in tumour and normal liver regions was measured by dynamic liver scintigraphy, showing that 60% have a predominantly arterial blood supply.

Topics: Colorectal Neoplasms; Humans; Liver; Liver Neoplasms; Neoplasm Staging; Preoperative Care; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

This report describes our experience with 16 infants and children with a mean age of 7 months and a median age of 6 weeks with hepatic hemangioendothelioma. Fifteen patients presented with hepatomegaly. Seven had congestive heart failure and four had associated cutaneous lesions. Although diagnosis was clinically evident in 15 of the 16 patients, arteriography and computerized tomography (CT) were diagnostic. A variety of treatment approaches were used including radiation, resection, systemic steroids, hepatic artery ligation, angiographic embolization, and various combinations of these modalities. The following information was gained from this experience. CT with enhancement is as specific a diagnostic tool as hepatic arteriography. Angiographic and CT appearances do not correlate with prognosis. Most patients can be treated successfully with steroids; those who do not respond should have other approaches tried such as embolization or ligation. The angiographic appearance determines whether embolization therapy is worthwhile, as we found that hemangioendotheliomatosis with portal as well as hepatic arterial supply will not respond to embolization. The survival rate in this series was 80%.

Topics: Adolescent; Child; Child, Preschool; Female; Hemangioendothelioma; Humans; Infant; Infant, Newborn; Liver Neoplasms; Male; Prednisone; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

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

Thirteen patients with a history of confirmed liver carcinoma were given either I131 goat polyclonal or murine monoclonal antibodies against alpha-fetoprotein (AFP), and then scanned with a gamma camera. In order to reduce background, nontarget activity, especially in the liver, blood pool, and reticuloendothelial system, 99mTc imaging agents were used for tumor image enhancement by computer-assisted subtraction. A sensitivity of 91% for the primary site, 50% for the lungs (33% for the chest area), and 75% for the abdomen and pelvis was achieved, with a specificity of 100%, 94%, and 100% for these sites, respectively. The accuracy was determined to be 93% for the liver, 86% for the lungs (77% for the chest), and 85% for the abdominal and pelvic area, resulting in an overall accuracy rate for imaging primary and metastatic hepatocellular cancer of 84% (90% if bone metastases are excluded). In two of the 13 patients, lesions that had been missed by conventional liver scintigraphy and transmission computed tomography (CT) were first shown by radioimmunodetection (RAID).

Topics: Abdominal Neoplasms; Adult; alpha-Fetoproteins; Antibodies; Antibodies, Monoclonal; Carcinoma, Hepatocellular; Child, Preschool; Female; Hemangiosarcoma; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Pelvic Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Thoracic Neoplasms

Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The objective of this study is to correlate the presence of bone and liver metastases in patients with breast cancer with respect to the results of bone and liver scans, axillary nodal status, and serum alkaline phosphatase levels. One hundred ninety-seven patients with breast cancer treated by modified radical mastectomy between the years 1978 and 1981 were studied. Fifty-nine (30%) of the total group had distant metastases during the course of observation of 60 to 96 months; of 35 patients in whom bone metastases developed, 30 had normal preoperative bone scan results. Of 21 patients who had liver metastases, 19 had normal preoperative liver scans. Nineteen (70%) of the 27 patients with abnormal bone scans had normal alkaline phosphatase levels. Seven (63%) of the 11 patients who had abnormal liver scans had a normal alkaline phosphatase. The study supports the concept that preoperative bone and liver scans are ineffective indicators of metastatic involvement. Selection of patients for screening by bone and liver scans according to alkaline phosphatase determinations was not supported by this study. The appropriate use of bone scans for screening in patients with breast carcinoma is suggested as a follow-up device in patients with positive lymph nodes.

Topics: Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; Diphosphates; Female; Humans; Liver Neoplasms; Mastectomy; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid

It is currently believed that hepatocellular adenoma is photon deficient on technetium-99m sulfur colloid scintigraphy because these tumors lack Kupffer cells. In a retrospective review of 13 pathologically proven cases of hepatocellular adenoma with technetium-99m sulfur colloid scintigrams, Kupffer cells were present in all 13 cases. We observed uptake of the radiocolloid by the hepatocellular adenoma in three cases (23%), and there were no histologic differences between the tumors with uptake and the ones without it. We conclude that the currently accepted reason for the lack of technetium-99m sulfur colloid uptake within hepatocellular adenoma is incorrect, and an explanation other than a lack of Kupffer cells is responsible for the photon-deficient appearance in the majority of cases of hepatocellular adenoma. Further, because hepatocellular adenoma may have technetium-99m sulfur colloid uptake in a significant percentage of cases, it should be added to focal nodular hyperplasia in the differential diagnosis of a hepatic mass with uptake by technetium-99m sulfur colloid.

Topics: Adolescent; Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Hyperplasia; Kupffer Cells; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

A total of 150 patients with primary carcinoma of the gastrointestinal tract had first-pass technetium colloid scintigraphy to estimate the hepatic perfusion index (HPI). Postoperative follow-up over 2-4 years shows that the HPI remains a sensitive method of detecting hepatic metastases, even in patients whose liver appeared normal at laparotomy. HPI was elevated in 94% of patients with liver metastases found at laparotomy; 87% of patients with occult metastases which became overt within 3 years of surgery had elevated HPI; and 91% of all patients who have to date developed hepatic metastases had elevated HPI at presentation. Of all patients with elevated HPI, 82% had metastases which were either apparent at surgery or became detectable by other means within 3 years.

Topics: Gastrointestinal Neoplasms; Humans; Liver Circulation; Liver Neoplasms; Perfusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Micrometastases were induced in Fisher rats using an intraportal inoculation of 0.2 ml of 8 x 10(7) Walker carcinosarcoma cells. A control group received normal saline. The hepatic perfusion index (HPI) was measured during the growth and development of micrometastases. The HPI at 4 days (0.51 +/- 0.008) and at 6 days (0.65 +/- 0.16) was significantly raised when compared to controls (0.31 +/- 0.07) and at 2 days after inoculation (0.31 +/- 0.06). Hepatic artery flow did not change throughout the study period. However, portal venous inflow was decreased significantly at 4 and 6 days (0.57 +/- 0.16 and 0.55 +/- 0.11) when compared to controls (0.96 +/- 0.34). These results indicate that the change in the hepatic perfusion index is related to a decrease in portal venous inflow. The decrease in portal venous inflow could be a mechanical effect of the micrometastases on intrahepatic blood flow or to increased arteriovenous shunting.

Topics: Animals; Carcinoma 256, Walker; Liver Circulation; Liver Neoplasms; Male; Neoplasm Transplantation; Perfusion; Radionuclide Imaging; Rats; Rats, Inbred F344; Technetium Tc 99m Sulfur Colloid

Isotope liver scanning is an accurate technique for detecting liver metastases from large bowel cancer. In this retrospective study of patients who had a resection for bowel cancer, the accuracy of liver scanning was 95%. However, the scan accuracy as defined by median survival time was insufficient to detect liver metastases missed by the surgeon at operation and did not alter the clinicopathological stage of the patient's disease.

Topics: Actuarial Analysis; Aged; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Male; Neoplasm Staging; Predictive Value of Tests; Radionuclide Imaging; Rectal Neoplasms; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

This report describes 21 cases of nodular regenerative hyperplasia (NRH) and its clinical and radiologic features. NRH of the liver is an established pathologic entity that should not be confused with focal nodular hyperplasia, hepatocellular adenoma, or the regenerative nodules associated with cirrhosis. Correct diagnosis will prevent an unnecessary hepatic lobectomy should NRH be mistaken for hepatocellular adenoma. Unlike focal nodular hyperplasia, NRH may bleed, may be associated with portal hypertension in one-half of cases, and is often associated with a systemic disease such as a myelo- or lymphoproliferative disorder. Correct diagnosis is important because the prognosis in patients with NRH and portal hypertension is better than that in patients with portal hypertension due to cirrhosis. Radiologically, multiple nodules, large masses, or an apparently normal liver (containing nodules less than 0.5 cm in diameter) were visible. The nodules may take up technetium sulfur colloid and have variable echogenicity on sonography. They are often hypodense on CT without significant enhancement. The nodules may fill from the periphery on angiography, are vascular, and sometimes contain small hypovascular areas due to hemorrhage. A large nodule may rupture and cause hemoperitoneum. These findings may resemble some features of focal nodular hyperplasia, hepatocellular adenoma, or metastases. NRH is probably underdiagnosed owing to a lack of recognition of the entity and limited sampling of liver tissue by needle biopsy. Scintigraphy, sonography, and CT of the liver should be performed in cases of idiopathic portal hypertension to detect NRH. In cases with compatible findings, multiple needle biopsies or a laparoscopically guided needle biopsy or wedge liver biopsy should be recommended for definitive diagnosis.

Topics: Adenoma; Adolescent; Adult; Aged; Angiography; Biopsy; Child; Diagnosis, Differential; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Liver Regeneration; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Carcinoid liver metastases may be more easily detected by radionuclide liver-spleen studies (RN imaging study) than by computed tomography (CT). While multiple studies have suggested that CT is a more sensitive test than the Tc-99m sulfur colloid study for the detection of most types of liver metastases, carcinoid tumors appear to be an exception. The results of 23 pairs of CT and RN imaging studies that were obtained within one month of each other in patients with proven carcinoid tumors are reported. Comparison of the initial reports of the studies as well as a blinded reinterpretation of the studies suggest that in this group of patients the RN imaging study appeared to be superior to CT in the evaluation of the response to therapy.

Topics: Carcinoid Tumor; Humans; Liver; Liver Neoplasms; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A rare case of a very unusual position of a normally functioning spleen in the posterior aspect of the right lobe of the liver is reported. A 6-year-old boy was evaluated with echocardiography for congenital heart disease of coexisting atrial and ventricular septal defects with pulmonary hypertension. Other associated cardiac abnormalities on this child included a right-sided aortic arch, drainage of the azygous vein into the superior vena cava and an Eisenmenger complex. At the time of echocardiography, absence of the spleen in its normal location was noted. This prompted further investigation into localizing the spleen using 99mTc-sulfur colloid and heat denatured 99mTc-RBC scintigraphy. Both scans demonstrated the spleen to lie posterior to the right hepatic lobe.

Topics: Child; Choristoma; Erythrocytes; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Spleen; Technetium; Technetium Tc 99m Sulfur Colloid

A focal defect detected by hepatic scintigraphy is a nonspecific finding with a large differential diagnosis. This paper describes a case of an ectopic intrahepatic gallbladder diagnosed by cholescintigraphy, thereby avoiding a potential false-positive liver scan.

Topics: Cholecystography; Choristoma; False Positive Reactions; Female; Gallbladder; Humans; Imino Acids; Liver; Liver Neoplasms; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

The importance of portal circulation in the delivery of drugs and nutrients to colorectal hepatic metastases is controversial. Using 13N (nitrogen 13) amino acids and ammonia with dynamic gamma camera imaging, we demonstrate, for the first time in human beings, a quantitative advantage of hepatic artery compared with portal vein infusion. Eleven patients were studied by hepatic artery injection, five patients were studied by portal vein injection, and two patients had injections through both routes. Data collected from the liver for 10 minutes after rapid bolus injection of 13N L-glutamate, L-glutamine, or ammonia were compared with 99mTc (technetium) macroaggregated albumin (MAA) images produced after injection through the hepatic artery or portal vein at the same session. Tumor regions defined from 99mTc sulfur colloid scans were compared with nearby liver areas of similar thickness. For the 13N compounds, the area-normalized count rate at first pass maximum (Qmax) and the tissue extraction efficiency were computed. The tumor/liver Qmax ratios for MAA and 13N compounds were highly correlated. Both tumor and liver extracted more than 70% of the nitrogenous compounds. The tumor/liver Qmax ratios reflect the relative delivery of injected tracer per unit volume of tissue. After hepatic artery injection the Qmax ratio was 1.03 +/- 0.33 (mean +/- SD), significantly exceeding the Qmax ratio of 0.50 +/- 0.34 after portal vein injection (P less than 0.003). Therefore, more than twice as much of a nutrient substrate is delivered per volume of tumor relative to liver by the hepatic artery as by the portal vein; the high extraction efficiency demonstrates that the hepatic artery flow is nutritive; and the delivery of substance in solution (such as nutrients or drugs) to tumor and liver tissue correlates with the distribution of colloids such as macroaggregated albumin after hepatic arterial and portal venous injection.

Topics: Adult; Aged; Colonic Neoplasms; Female; Glutamine; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Rectal Neoplasms; Regional Blood Flow; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

The scintigraphic findings on sulfur colloid liver-spleen imaging, Tc-99m labeled RBC blood pool imaging, and Tc-99m MDP bone imaging in four patients with infantile hemangioendothelioma are described. Thirteen radionuclide studies were performed, with serial sulfur colloid images obtained in three patients, allowing interval assessment of liver size and tumor involvement. Findings of Tc-99m MDP uptake in the livers of two patients with hemangioendothelioma and diffuse increase in hepatic RBC labeled blood pool activity in one patient also are reported.

Topics: Child, Preschool; Erythrocytes; Female; Hemangioendothelioma; Humans; Infant; Infant, Newborn; Liver Neoplasms; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Two patients who underwent successful resections for uninodular hepatomas in non-cirrhotic livers were readmitted with late recurrences. Both had multiple imaging procedures prior to treatment including computed tomography, magnetic resonance imaging, and angiography. I recommend periodic ultrasonography and alphafetoprotein assay in the follow-up of patients who have had a hepatoma resected and I indicate when additional imaging methods are required.

Topics: Adult; Aged; Angiography; Carcinoma, Hepatocellular; Female; Gallium Radioisotopes; Humans; Liver Neoplasms; Magnetic Resonance Spectroscopy; Neoplasm Recurrence, Local; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A case of hepatocellular carcinoma (HCC) complicated by the Budd-Chiari syndrome is described. The antemortem diagnosis of both conditions was made with the unique findings of multitracer scintigraphy. The difficulty of diagnosing these two conditions by the conventional approach is reviewed. The advantages of using multitracer scintigraphy for evaluation of hepatic lesions are also discussed.

Topics: Budd-Chiari Syndrome; Carcinoma, Hepatocellular; Humans; Liver Circulation; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

To determine the accuracy of liver sonography in the diagnosis of liver metastases, the results of 99 patients with breast or lung cancer were compared with liver scintigraphy, physical examination, laboratory tests, histological examination and clinical follow-up. Liver sonography proved to be an accurate method to demonstrate or exclude liver metastases, with a sensitivity of 78.6% and a specificity of 90.0%. The highest accuracy was achieved if the sonographic examination of the liver was performed while there was a clinical suspicion of liver metastases and if compoundscan sonography was supplemented by real-time sonography.

Topics: Breast Neoplasms; Carcinoma, Bronchogenic; Humans; Liver Function Tests; Liver Neoplasms; Lung Neoplasms; Physical Examination; Retrospective Studies; Technetium Tc 99m Sulfur Colloid; Ultrasonography

A false-positive radiocolloid liver image can occur in various disease processes from extrinsic structures adjacent to the liver. A patient whose radiocolloid liver imaging showed an apparent photopenic area in the liver is presented; the abdominal CT demonstrated a low-density lesion located anterior to the liver, and at surgery the lesion was confirmed to be a right anterior subphrenic abscess.

Topics: False Positive Reactions; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Subphrenic Abscess; Technetium Tc 99m Sulfur Colloid

A model for hepatic arterial chemotherapy studies using large dogs and an implantable infusion pump has been developed. Using this technique near complete perfusion (greater than 90%) of the liver can be achieved in vivo as determined by hepatic arterial perfusion scintigraphy with technitium 99m macroaggregated albumin. The system is reliable and has been in use for a total of 1353 days (mean of 104 days, range 52-239) in 13 dogs. Pump implantation causes no apparent acute liver damage based on pre- and post-operative alkaline phosphatase and serum glutamic-pyruvic transaminase determinations and does not affect the general mobility or behavior of the animals. Careful placement of the catheter and attention to the physicochemical properties of the solutions loaded are factors contributing to the success of the model. The model permits comprehensive preclinical pharmacokinetic and toxicologic studies of new or preexistent chemotherapeutic agents in the same device that will be used for later administration in human subjects. By providing the means to examine and develop new treatment modalities, it enables the design of even more potent cytotoxic therapy directed into the tumor vascular bed.

Topics: Animals; Antineoplastic Agents; Bromodeoxyuridine; Catheterization; Dogs; Hepatic Artery; Infusion Pumps; Liver; Liver Function Tests; Liver Neoplasms; Models, Biological; Pharmaceutical Preparations; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; 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

Twenty-three patients with hepatic cirrhosis and focal defects on Tc-99m sulfur colloid (SC) scintigrams were restudied with In-111 chloride to determine if indium localization in the focal defect is indicative of a hepatoma. Seven of eight patients with proven hepatomas had positive studies; however, six of 15 patients without hepatomas also had studies interpreted as positive. Thus, In-111 chloride is highly sensitive for the detection of hepatomas, and a negative indium study would militate against this diagnosis. The high false-positive rate found may be due to technical factors rather than a lack of specificity of localization; the experience of others seems to support this impression. At present, In-111 chloride scintigraphy for focal hepatic defects appears to be useful in ruling out hepatoma.

Topics: Carcinoma, Hepatocellular; False Positive Reactions; Humans; Indium; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Sequential liver scintiphotography with Tc-99m pyrophosphate (PYP) was used to prospectively evaluate its uptake patterns in hepatoma. The scintiphotos and time-activity curves of 40 cases were analyzed. Two distinct patterns of tumor activity were noted: gradual but complete extraction and trapping of Tc-99m PYP in hepatoma in 38% of the patients (group 1), and absence of subsequent Tc-99m PYP uptake in hepatoma after initial blood pool activity in 62% of the patients (group 2). Since extraction and trapping of Tc-99m PYP occur approximately in two fifths of the patients with hepatoma, we conclude that Tc-99m PYP liver scintigraphy is not worthwhile supplementing the conventional radionuclide studies for diagnosing hepatoma, even in the selected patients in the countries where the prevalence of hepatoma is high.

Topics: Carcinoma, Hepatocellular; Diphosphates; Humans; Liver; Liver Neoplasms; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid; Time Factors

A patient exhibited an unusual constellation of findings: His extraosseous lymphoma sequestered [99mTc]MDP, a bone-seeking agent, while at the same time it appeared to produce a factor that caused hypercalcemia. The dispersed lymphoma cells took up more [99mTc]MDP in vitro than did cultured lymphoblasts suggesting that the in vivo sequestration may have been, at least in part, an active intracellular process.

Topics: Cells, Cultured; Diphosphonates; Humans; Hypercalcemia; Liver; Liver Neoplasms; Lymphocytes; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Some forms of glycogen storage disease (GSD) primarily affect the liver, including types I, III, IV, VI, IX and 0. Scanning with Tc-99m sulfur colloid, while not being specific, does reveal some characteristic features. Most experience is with scanning in type I disease, though there are few reports in the literature. Six patients with type I, type III, type IV, and probably type VI disease are presented in this report. GSD should be considered in infants and young children presenting with hepatomegaly and abnormal liver-spleen scans. Sequential imaging is useful in following these patients. When focal defects are present, long term follow-up is indicated to detect hepatocellular adenocarcinoma.

Topics: Adenocarcinoma; Adolescent; Adult; Child, Preschool; Female; Follow-Up Studies; Glycogen Storage Disease; Glycogen Storage Disease Type I; Glycogen Storage Disease Type II; Glycogen Storage Disease Type III; Glycogen Storage Disease Type IV; Glycogen Storage Disease Type VI; Humans; Infant; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

As the most common benign hepatic tumor, hepatic hemangioma may be misinterpreted during radiographic cancer staging, inadvertently biopsied, or pursued surgically as a solitary malignancy. Two cases of hepatic hemangiomas discovered during hepatobiliary scintigraphy are presented: the first involving multiple anechoic lesions by ultrasound and the second involving a solitary echogenic lesion by ultrasound. Whereas the former patient eventuated in surgery solely for the evaluation of a space-occupying lesion, the latter was totally obstructed at the common bile duct; both patients' hemangiomas were documented surgically.

Topics: Adult; Female; Hemangioma, Cavernous; Humans; Imino Acids; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Hepatic cavernous hemangiomas are benign tumors of the liver that are often an incidental finding. They are usually asymptomatic but may cause symptoms when traumatized, may bleed spontaneously, or may produce pain by virtue of their large size and mass effect. A retrospective analysis of the clinical presentation, liver function tests, and diagnostic imaging procedures in 20 patients with hepatic hemangiomas is presented and the literature is reviewed. The 20 patients had 27 mass lesions as seen on liver scintigraphy, computed tomography, or sonography. Technetium-99m-labeled red blood cell flow studies and blood pool scintigrams showed delayed filling of the mass lesions, diagnostic of hemangiomas. This finding was not encountered in any other type of lesion. A new diagnostic algorithm is proposed in which blood-flow and blood-pool scintigraphy play a more prominent role in the diagnostic workup. According to this algorithm, if liver function tests in a patient with hepatic mass are either normal or abnormal and suggestive of hepatocellular dysfunction, the patient should undergo hepatic blood-flow and blood-pool studies.

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

Liver scintigraphy (99Tcm sulphur colloid) was performed in 118 patients with malignant melanoma. In 73 patients diagnosed as stage I, the pretreatment evaluation showed one false-negative and one false-positive examination. During follow-up there were ten abnormal liver scintigraphies; one was later correlated to liver metastases. In 46 patients diagnosed as stage II-IV, the pretreatment liver scintigraphy yielded false-negative results in 36% and false-positive results in 15%. The predictive values of positive and negative tests were 44% and 81%, respectively. The yields of liver tests (S-alkaline phosphatase, S-gamma-glutamyl-transferase) in patients with liver metastases were low. This study demonstrated the limitations of liver scintigraphy for diagnosis of liver metastases in patients with malignant melanoma.

Topics: Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Follow-Up Studies; Humans; Liver; Liver Neoplasms; Melanoma; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Diagnosis, Differential; False Positive Reactions; Humans; Liver; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Fifty-five consecutive patients with colorectal carcinoma and hepatic metastases on the Tc-99m sulfur colloid liver/spleen scan (TSC) were evaluated to see if the pattern of spread of colorectal metastases was affected by the venous drainage of the primary site. The results suggest that significant streaming probably exists in the portal vein and the spread of metastases to the liver is affected by it. This information has a potential clinical implication in terms of diagnostic workup and chemotherapeutic infusions. It also supports the speculation that a streaming effect exists in humans.

Topics: Aged; Colonic Neoplasms; Female; Humans; Liver Circulation; Liver Neoplasms; Male; Middle Aged; Portal Vein; Radionuclide Imaging; Rectal Neoplasms; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Female; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Spleen; Stomach Neoplasms; Technetium; Technetium Tc 99m Sulfur Colloid

Single photon emission computerized tomography coupled with Tc-99m MAA hepatic-arterial perfusion scintigraphy has been used to examine the density of the functional microcirculation of hepatic tumors relative to normal liver in 24 patients. In both colorectal and carcinoid tumors we have demonstrated an average three-fold greater arteriolar-capillary density in areas of tumor proliferation. The depth of the evoked tumor hypervascularity was found to extend about 4 cm. Tumors greater than 8-9 cm in diameter were uniformly found to have a central hypovascular core. These observations are of importance in the design of selective strategies utilizing therapeutic microspheres directed against the hypervascular proliferating regions of human tumors.

Topics: Adult; Aged; Biopsy; Carcinoid Tumor; Carcinoma, Hepatocellular; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Male; Microcirculation; Middle Aged; Particle Size; Serum Albumin; Sulfur; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Adult; Carcinoma; Colloids; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver Neoplasms; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The role of ultrasonography, computed tomography (CT), and radioisotopic scanning in the staging of bilharzial bladder cancer has not been reported previously. Forty patients with invasive bladder cancer seen at the King Faisal Specialist Hospital and Research Centre between January 1978 and June 1981 underwent complete preoperative workup for staging of their tumors prior to radical cystectomy. The preoperative radiologic investigations included excretory urography (IVP), ultrasonography (US), CT of the pelvis, and liver and bone scans. The results of these investigations were compared with the operative and pathologic staging. Ninety-three percent of the patients with bilharzial cancer had evidence of ureteric obstruction on IVP compared with 22% of the nonbilharzial cancer patients. The presence of ureteric obstruction in these patients did not correlate with the stage of the disease with 83% of the patients with superficial tumors (T1 and T2) having hydroureteronephrosis. Ultrasonography and CT had an 83% accuracy in the staging of superficial tumors. Stage T3 tumors were understaged in 14% of the cases. Ultrasonography did not differentiate Stages T3 and T4 tumors while CT scan differentiated these two stages in 57% of the cases. Bone scan failed to reveal evidence of metastatic disease in any of the bilharzial cancer patients. Liver scan was suspicious for liver metastases in two patients with bilharzial cancers in whom open liver biopsy revealed only hepatic bilharziasis. Of all the radiographic studies, US or preferably CT scan seem to be of some value in the staging of bilharzial tumors localized to the bladder. Bone and liver scans are probably of no cost effective benefit.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Diphosphonates; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Prognosis; Radionuclide Imaging; Schistosomiasis; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography; Urinary Bladder Neoplasms; Urography

Prognosis and proper treatment in Hodgkin's disease (HD) are strictly related to staging accuracy: liver and spleen involvement is of particular importance in this regard. We have evaluated, in 113 consecutive patients, the accuracy of clinical parameters to detect histologically documented HD involvement by comparing hepatosplenomegaly, liver function tests, liver and spleen scan, inspection of liver and spleen surface at laparoscopy with histologic findings. Our data suggest that of all the parameters studied, laparoscopy has the highest sensitivity and specificity values (about 100%). Laparoscopy may precede laparotomy as a staging procedure in HD and may give, in patients not submitted to laparotomy whatever the reasons, very reliable information.

Topics: Adolescent; Adult; Aged; Hodgkin Disease; Humans; Laparoscopy; Laparotomy; Liver Function Tests; Liver Neoplasms; Middle Aged; Neoplasm Staging; Prognosis; Splenic Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

One hundred fifty-seven consecutive patients with small cell lung cancer seen at the National Cancer Institute over a four-year period underwent a series of pretherapy liver staging procedures to determine optimal means of detection and prognostic implications of hepatic metastases. Liver evaluation included physical examination, liver function tests, and liver scan (radionuclide or computerized tomography [CT]), as well as percutaneous and/or peritoneoscopy-directed liver biopsy when possible (74%). Liver metastases were detected in 26% of patients. Peritoneoscopy was the most sensitive method of liver evaluation and increased the detection of liver metastases when done in a sequential fashion after percutaneous liver biopsy from 18 to a total of 27 patients. Of the noninvasive procedures, radionuclide and CT liver scan were the most accurate concurring with liver biopsy in 87% of patients but permitting correct discrimination of stage in excess of 96% of patients. The accuracy of this noninvasive procedure was enhanced by an algorithm combining the results of radionuclide liver scan with liver function tests to detect patients with high or low likelihood of liver involvement. The survival and response of patients with liver metastases was significantly worse than those without such metastases with no three-year disease-free survivors among patients with liver metastases.

Topics: Actuarial Analysis; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Carcinoma, Small Cell; Female; Humans; Liver Function Tests; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

This is a case report of macronodular TB of the liver, without other known organ involvement, which presented with defects on RN scan and hypoechoic areas by ultrasound, suggesting metastatic disease. The demonstration on liver scan is quite rare and ultrasound visualization has not been reported. Although confirmation could not be obtained with AFB stain or positive culture, the clinical and liver scan response with a highly suggestive histologic picture are sufficient to make the diagnosis.

Topics: Adult; Colloids; Diagnosis, Differential; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tuberculosis, Hepatic; Ultrasonography

A renal mass was correctly identified with Tc-99m sulfur colloid liver-spleen scan and Tc-99m glucoheptonate scintigraphy while CT scan was misinterpreted as showing a hepatic lesion.

Topics: Aged; Carcinoma, Renal Cell; Diagnosis, Differential; Humans; Kidney Neoplasms; Liver Neoplasms; Male; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; 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: Adenoma; Adult; Female; Humans; Imino Acids; Liver Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

A case of hepatic adenoma is reported, presenting as a defect on sulfur colloid liver image and visualized on a biliary scintigram. Although biliary imaging in the evaluation of sulfur colloid defects may be of value in selected patients, combination imaging in this case could not distinguish a benign from a malignant process.

Topics: Adenoma; Aged; Biliary Tract; Diagnosis, Differential; Humans; Imino Acids; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

Thirty-four patients with surgically documented medullary carcinoma of the thyroid (MCT) and elevated serum calcitonin levels had Tc-99m phosphate bone and/or Tc-99m sulfur colloid liver images for suspected metastases. Liver images demonstrated metastatic lesions in nine of 32 patients (28%). Bone images were positive for metastases in eight of 30 patients (27%). Four of these eight abnormal bone studies detected only skeletal lesions, two demonstrated only extraosseous metastases, and two showed both kinds. Of 18 patients with both radionuclide bone studies and skeletal radiographs, four demonstrated skeletal metastases, and lesions were recognized on both examinations. This study demonstrates that radionuclide bone and liver images frequently detect metastatic lesions in patients with MCT and elevated serum calcitonin levels, and that some nonskeletal metastases in patients with this tumor display an unusual affinity for bone-seeking radiotracers.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Carcinoma; Child; Female; Humans; Liver Neoplasms; Male; Middle Aged; Phosphates; Radiography; Radionuclide Imaging; Splenic Neoplasms; Technetium; Technetium Tc 99m Sulfur Colloid; Thyroid Neoplasms

Topics: Aged; Colloids; Gallium Radioisotopes; Hemangiosarcoma; Humans; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Colloids; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A retrospective study was undertaken to evaluate the role of computed tomography (CT) in increasing the specificity of the abnormal radiocolloid liver-spleen scan. During a 12-month period, 124 patients with focal abnormalities on hepatic scintiscans were identified out of 523 consecutive radionuclide studies. Of these 124 patients, 38 had subsequent CT examination(s) of the liver. Of this group, 11 patients with suspected metastatic disease with focal defects on hepatic scintiscans had normal hepatic CT scans and subsequent negative follow-up for hepatic disease. False-positive radionuclide scan abnormalities, related either to anatomic variation in liver configuration or adjacent extrahepatic structures influencing the radiocolloid scan, are readily recognized and explained on the basis of CT examination.

Topics: Adult; Aged; Diagnosis, Differential; False Positive Reactions; Female; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Adenocarcinoma; Aged; Humans; Imino Acids; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Disofenin; 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

Based on strict predefined histologic criteria, we identified 23 patients with hepatic adenoma and 41 patients with focal nodular hyperplasia seen at this institution between 1961 and 1980. Patients with hepatic adenoma were young and 91% were female. When a reliable history was available, 89% had used oral contraceptives; 53% presented acutely or with pain. Eleven of 11 radionuclide scans were abnormal; 15 of 15 angiograms showed a hypervascular mass with 7 of 15 showing areas of hypovascularity. Eighteen resections were performed with one operative death. Two tumors contained areas of unequivocal hepatocellular carcinoma. Fifteen of 18 patients followed for 82 +/- 11 mo were living and well and had discontinued oral contraceptives. Focal nodular hyperplasia patients were older, 88% were female, and 58% had used oral contraceptives. Their lesions were discovered accidentally. Seven of 12 radionuclide scans demonstrated voids, while 13 of 13 angiograms showed hypervascular lesions with no areas of hypovascularity. Seventeen tumors were resected. Twenty-three of 24 patients followed for 45 +/- 7 mo were living and well. One died of nonhepatic causes. Based on the findings of this review, we believe that if the clinical suspicion of hepatic adenoma or focal nodular hyperplasia is strong, elective laparotomy for diagnosis is usually the best approach. Hepatic adenoma should be resected if technically feasible. Intraoperative wedge biopsy is appropriate for focal nodular hyperplasia.

Topics: Abdomen; Adult; Biopsy; Carcinoma, Hepatocellular; Contraceptives, Oral; Diagnostic Techniques, Surgical; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Male; Middle Aged; Pain; Palpation; Prognosis; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

Accurate detection of hepatic metastases is necessary to properly stage and follow many malignancies. Nineteen patients underwent computed tomographic (CT) examination with ethiodized oil emulsion 13 (EOE-CT) and liver scintigraphy within 1 month of an exploratory laparotomy. The sensitivity, specificity, and accuracy of these two imaging procedures were evaluated statistically. No differences were seen when the patients were scored as positive or negative for metastases. However, in a lesion-by-lesion analysis of 58 hepatic lesions, the sensitivity of EOE-CT was 69.0% and the sensitivity of scintigraphy was 32.8% (p less than 0.001). All lesions detected scintigraphy were also detected by EOE-CT. EOE-CT had a size threshold of 1.0-1.5 cm, while liver scintigraphy had a threshold of 2.5-3.0 cm. EOE-CT is a more sensitive examination for detection of small hepatic metastases than liver scintigraphy.

Topics: Contrast Media; Ethiodized Oil; Humans; Liver; Liver Neoplasms; Neoplasm Staging; Radionuclide Imaging; Retrospective Studies; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Aged; Female; Gallium Radioisotopes; Humans; Liver Neoplasms; Mediastinal Neoplasms; Plasmacytoma; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Gallium Radioisotopes; Humans; Iodine Radioisotopes; Liver Neoplasms; Methods; Respiration; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

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

A prospective evaluation of computed tomography (CT), ultrasonography (US), and Tc-99m sulfur colloid scintigraphy of the liver was performed in 189 patients who had either colon (n = 129) or breast (n = 60) carcinoma. Imaging was performed with fourth-generation CT scanners, gray-scale or phased array ultrasound scanners, and 37-tube gamma cameras. Studies were evaluated independently and receiver operating characteristic (ROC) curves were constructed. In addition, a standard 2 X 2 matrix analysis was performed. In patients who had all three examinations (n = 122), the matrix analysis showed that CT had a slightly higher sensitivity (0.93) than scintigraphy (0.86) or US (0.82); specificities were 0.88, 0.83, and 0.85, respectively. These differences were not statistically significant. However, ROC curves showed that CT had the highest true-positive ratio at every false-positive ratio, and that US had the lowest. The performance of CT did not differ significantly from that of scintigraphy, but was better than that of US (p less than .05), especially in patients with breast carcinoma. Overall, CT provided the most accurate means for detecting liver metastases from both primary lesions.

Topics: Breast Neoplasms; Carcinoma; Colloids; Colonic Neoplasms; Diatrizoate; Diatrizoate Meglumine; False Positive Reactions; Female; Humans; Liver; Liver Neoplasms; Male; Prospective Studies; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Nine patients with colonic carcinoma were studied with I-131-labeled F(ab')2 fragments of an anti-colorectal carcinoma monoclonal antibody. A total of 69% of colon cancer sites were detected without background subtraction; metastases from a concurrent breast carcinoma in one patient were not seen. Lesions ranged from 1.5 to 8 cm. The mean thyroid uptake of I-131 at 24 hours was 0.25%. Half-lives of I-131 in the blood (protein-bound and total) fit a two-compartment model, with half-lives of 3.5 and 27.6 hours for the protein-bound fraction and 3.6 and 23.8 hours for total I-131. Using quantitative methods, a mean value of 0.0047%/cm3 of the administered dose was localized in the tumor at peak concentration, which occurred approximately 48 hours post-administration. This has implications for therapy planning.

Topics: Antibodies, Monoclonal; Carcinoma; Colonic Neoplasms; Erythrocytes; Humans; Immunoglobulin Fab Fragments; Iodine Radioisotopes; Liver Neoplasms; Lung Neoplasms; Radionuclide Imaging; Retroperitoneal Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Biopsy; Diagnosis, Differential; Female; Humans; Liver Neoplasms; Pancreatic Cyst; Pancreatic Pseudocyst; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Aged; False Positive Reactions; Gallium Radioisotopes; Humans; Liver Neoplasms; Lung Neoplasms; Male; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Twenty-nine small (less than 5 cm) hepatocellular carcinomas in 18 patients were examined by radionuclide imaging (RN), ultrasound (US), computed tomography (CT), hepatic angiography, and serum alpha 1-fetoprotein (AFP) assay. Sensitivity was 39% with RN, 50% with US, 56% with CT, and 94% with angiography, including infusion hepatic angiography (IHA). Lesions larger than 3 cm could be detected by all of these methods; those between 2 and 3 cm were generally shown by US and CT but not RN. IHA was essential for diagnosis of lesions less than 2 cm, which were otherwise difficult or impossible to detect except with angiography. As a screening method, AFP was best, followed by US and CT. The authors recommend using AFP and US to minimize expense and radiation exposure. In questionable cases, IHA should be performed.

Topics: Adult; Aged; alpha-Fetoproteins; Angiography; Carcinoma, Hepatocellular; Diatrizoate Meglumine; Female; Humans; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

This prospective study of 80 patients compared the results of liver scintiscan, ultrasound, and CT scan to the objective findings recorded at laparotomy. Analysis of these data revealed no significant differences in sensitivity, specificity, or accuracy among these three imaging procedures, although a trend toward increased accuracy of the CT scan was noted. In a composite analysis, the accuracy was not improved by combining two or all three of these examinations. A lesion by lesion analysis revealed the inability of any of the three currently used techniques to accurately detect lesions less than 3 cm in diameter.

Topics: Biopsy; Carcinoma, Hepatocellular; Evaluation Studies as Topic; False Positive Reactions; Humans; Liver Neoplasms; Prospective Studies; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; 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

Topics: Carcinoma, Hepatocellular; Child; Child, Preschool; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Two children being treated with combination chemotherapy and irradiation for localized, rightsided Wilms' tumor developed sudden enlargement of the liver with defects on liver scintigram resembling liver metastases. One child also developed pancytopenia. When chemotherapy was temporarily withheld in both children, hepatomegaly and scintigram abnormalities resolved. The planned courses of chemotherapy were subsequently completed without complications. The clinical course in our patients is compared to previously published experiences. Awareness of this complication could prevent the mistaken diagnosis of metastatic disease and emphasizes the care necessary when administering cytotoxic drugs to children receiving irradiation to all or a portion of the liver.

Topics: Antineoplastic Agents; Child, Preschool; Dactinomycin; Diagnostic Errors; Doxorubicin; Drug Therapy, Combination; Female; Hepatomegaly; Humans; Kidney Neoplasms; Liver Neoplasms; Male; Radionuclide Imaging; Radiotherapy Dosage; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Vincristine; Wilms Tumor

The authors have reviewed their experiences in determining the presence of liver metastases in 103 patients by radiocolloid scanning. The sensitivity of liver scanning proved to be quite low if the presence of focal defects in the distribution of the tracer was chosen as the diagnostic criterion. The inclusion of less restrictive criteria such as liver enlargement or irregular distribution of the tracer, resulted in a higher sensitivity without lowering the predictive value of a negative scan. Using the latter diagnostic criterion, sensitivity, specificity and accuracy were in the range of 90%. Abnormal liver scans are common in patients classified at T3-T4 or N+ and their chances of being "true positive" are high. Conversely, abnormal scans are seldom found in patients classified at T1-T2 or N0 and probabilities of "false positive" results are high.

Topics: Breast Neoplasms; Decision Theory; Female; Gold Colloid, Radioactive; Humans; Liver Neoplasms; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The authors have reviewed their experiences in determining the presence of liver metastases in 103 patients by radiocolloid scanning. The sensitivity of liver scanning proved to be quite low if the presence of focal defects of tracer's distribution was chosen as the diagnostic criterion. The inclusion of less restrictive criteria, such as liver enlargement or irregular distribution of the tracer, resulted in an higher sensitivity without lowering the predictive value of a negative scan. Using the more extensive diagnostic criterion, sensitivity, specificity and accuracy were in the range of 90%. Abnormal liver scans are common in patients classified as T3-T4 or N+ and their chances of to be "true positives" are high. Conversely, abnormal scans are seldom found in patients classified as T1-T2 or N0 and chances of "false positives" are high.

Topics: Breast Neoplasms; False Negative Reactions; False Positive Reactions; Female; Gold Colloid, Radioactive; Humans; Liver; Liver Neoplasms; Lymphatic Metastasis; Neoplasm Staging; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Between 1978 and 1980, 33 patients with cervical cancer, 40 patients with ovarian cancer, and 28 patients with uterine cancer underwent clinical diagnostic staging. Fifty-four patients had bone scans, and 101 patients received liver scans as a part of their staging work-up. No positive bone scan results were found. Eight of 33 patients with Stage IV disease had positive liver scan results consistent with hepatic metastases. Only 1 of 69 patients with Stage I-III disease had a positive test for metastases. While these numbers are small, the authors conclude that bone and liver scanning in asymptomatic patients with early stage gynecologic cancers may not be warranted as staging procedures.

Topics: Bone and Bones; Bone Neoplasms; Diphosphonates; Female; Genital Neoplasms, Female; Humans; Liver; Liver Neoplasms; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Time Factors

To evaluate the cost-effectiveness of liver and bone isotope scans results were reviewed in 114 patients with invasive transitional cell carcinoma of the bladder. In 100 patients cystectomy was performed. In no patient has the results of the scans influenced or changed treatment. Routine use of isotope scans is not warranted for the preoperative evaluation of bladder cancer patients.

Topics: Bone and Bones; Bone Neoplasms; Carcinoma, Transitional Cell; Cost-Benefit Analysis; Female; Humans; Liver; Liver Neoplasms; Male; Preoperative Care; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Urinary Bladder Neoplasms

Topics: Aged; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Female; Gallium Radioisotopes; Humans; Liver; Liver Neoplasms; Male; Neoplastic Cells, Circulating; Prostatic Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Colloids; Drug Evaluation; Hodgkin Disease; Humans; Liver; Liver Neoplasms; Organotechnetium Compounds; Phytic Acid; Rhenium; Spleen; Splenic Neoplasms; Sulfur; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The use of multiple imaging modalities to diagnose hepatic hemangioendothelioma in a neonate is demonstrated. This approach avoided operative intervention to establish the diagnosis. Tc-99m sulfur colloid and Tc-99m PIPIDA scintigraphy was used to define the nature of sonographic hypoechoic structures in the liver, and angiography was employed to confirm the suspected diagnosis.

Topics: Hemangioendothelioma; Humans; Imino Acids; Infant, Newborn; Infant, Newborn, Diseases; Liver; Liver Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

Hepatic scintigraphy was performed prior to surgical exploration in 89 patients with primary carcinoma of the large bowel. Of these patients, 26% had positive liver scans at the time the diagnosis was established. The presence or absence of liver metastasis by scintigraphic criteria was correlated with surgical findings, a modified Duke pathologic classification, and the presence of tumor markers. The sensitivity of hepatic scintigraphy was 96% and the specificity was 98%. A total of 63% of patients with abdominal lymph node involvement had positive liver scans while 4.6% of patients without lymph node involvement had positive scans. A total of 91% of patients with positive liver scans had positive abdominal nodes. Of 60 patients with normal liver scans, one (1.7%) had hepatic metastasis and 27% had tumor in regional lymph nodes. Hepatic scintigraphy is highly sensitive in detecting liver metastasis from large bowel carcinoma. However, a negative liver scan did not exclude abdominal lymph node spread.

Topics: Adult; Aged; Carcinoma; Colonic Neoplasms; Female; Humans; Liver; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Splenosis is an unusual complication of splenic trauma. The computed tomographic (CT) appearance of splenosis is described. One should consider this diagnosis when faced with a history of splenic trauma and multiple round or oval masses at CT.

Topics: Adult; Choristoma; Humans; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Spleen; Splenectomy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Biliary Tract Diseases; Diagnosis, Differential; False Positive Reactions; Humans; Imino Acids; Liver; Liver Neoplasms; Radionuclide Imaging; Rhenium; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Carcinoembryonic Antigen; Child; Diagnostic Techniques, Surgical; Female; gamma-Glutamyltransferase; Humans; Liver Neoplasms; Male; Middle Aged; Statistics as Topic; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Ultrasonography

Topics: Adult; Carcinoma, Hepatocellular; Colloids; Female; Humans; Liver Neoplasms; Neoplasms, Multiple Primary; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Staging bone scans or skeletal surveys were obtained of 97 patients with endometrial carcinoma. Of the 77 patients with Stage I or II disease, no metastases were identified at staging. Three patients in the entire series demonstrated bony metastases; all of these metastases were detectable by radionuclide bone scan and radiographic bone survey. Eighty-nine patients were examined with radionuclide liver/spleen scanning at the time of staging. Four of the 89 initial scans were interpreted as demonstrating hepatocellular disease, and all four patients had abnormal liver function studies. Only one patient demonstrated a possible hepatic metastasis at initial diagnosis. This patient also had abnormal liver function studies. Based on these results, bone surveys and radionuclide bone scans are not indicated as screening procedures in endometrial carcinoma. It is suggested that screening for liver metastases in patients with endometrial carcinoma is not warranted in patients with normal liver function studies.

Topics: Bone Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Female; Humans; Liver Neoplasms; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Uterine Neoplasms

Topics: Adolescent; Adult; Carcinoma, Hepatocellular; Child; Glycogen Storage Disease Type I; Hepatomegaly; Humans; Liver Neoplasms; Male; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

A new radiopharmaceutical, 68Ga ion hydroxide colloid, for hepatic imaging by positron emission tomography was prepared from the eluate of a 68Ge-68Ga solvent extraction generator. In rats, 84% of the administered dose of colloid localized in the liver and 4.6% accumulated in the spleen. Initial imaging studies in normal dogs showed close correspondence of the findings by positron tomography and transmission computed tomography. Emission tomography with 68Ga-colloid was performed in 10 patients with hepatic metastases demonstrated by conventional 99mTc sulfur colloid scintigraphy. All focal defects noted on the conventional scintigrams were easily identified and generally were seen more clearly by positron tomography. In one patient, additional lesions not identified on the initial 99mTc sulfur colloid images were demonstrated. The positron tomographic images were compared with those obtained by transmission computed tomography in seven patients; the two studies showed comparable findings in five patients, whereas positron tomography more clearly showed multiple lesions in two. Our results suggest that positron emission tomography is a suitable technique for obtaining high contrast, cross-sectional images of large abdominal organs.

Topics: Animals; Evaluation Studies as Topic; Female; Gallium Radioisotopes; Humans; Liver Neoplasms; Male; Middle Aged; Rats; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Technology, Radiologic; Tomography, Emission-Computed

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

Topics: Hamartoma; Humans; Infant; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

Radionuclide scintigraphy was performed in 46 children with rhabdomyosarcoma. Of the 63 radiologically confirmed sites of bone disease, 76% were detected by 99mTc-labeled phosphate uptake. All 15 sites of hepatic involvement and eight of the nine cranial sites of disease exhibited isotope accumulation. Gallium 67 scans showed 57% of the 43 proven sites of disease, including four previously unsuspected areas. Twelve false-positive sites were obtained with gallium. Radionuclide scanning is a valuable aid in the diagnostic evaluation and management of childhood rhabdomyosarcoma.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; False Positive Reactions; Female; Gallium Radioisotopes; Head and Neck Neoplasms; Humans; Infant; Infant, Newborn; Liver Neoplasms; Male; Radionuclide Imaging; Rhabdomyosarcoma; Splenic Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Urogenital Neoplasms

The results of radionuclide (RN) liver scans, computed tomography (CT), and ultrasonography (US) were compared in 163 patients. Thirty-eight patients had all three studies, while ten were examined by CT and RN liver scans. One hundred fifteen patients had only US and RN studies. Radionuclide liver scanning demonstrated more false positive and negative studies than CT or US. Also, CT and US demonstrated more areas of metastasis during a single examination than RN liver scans. Ultrasonography displayed roughly the same accuracy of CT when a technically adequate examination was obtained. However, US was hampered by technically inadequate studies in 19% of 153 patients because of interfering intestinal gas. Computed tomography proved the most accurate and reliable modality in 48 patients.

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

Fourteen patients with hepatic hemangiomas were evaluated by Tc-99m colloid scintigraphy and Tc-99m RBC angiography, including flow studies and early and delayed static studies. On colloid scintigraphy, the liver appeared enlarged, with single or multiple focal defects. During the flow and early static Tc-99m RBC studies, the lesions showed poor perfusion and were filled only partially or not at all. Delayed Tc-99m RBC studies demonstrated the whole extent of the lesion and all the lesions when multiple hemangiomas were present. A flow study showing decreased perfusion and a late blood-pool study showing increased local blood volume appear characteristic of hemangiomas. Liver biopsy should not be attempted in such cases.

Topics: Angiography; Hemangioma; Humans; Liver; Liver Neoplasms; Perfusion; Radionuclide Imaging; Regional Blood Flow; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Colloids; Diagnosis, Differential; Humans; Liver; Liver Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

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

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

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

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

A patient is described who demonstrated accumulation of Tc-99m-sulfur colloid in both the lung and kidney following treatment for disseminated intravascular coagulation. This phenomenon has been demonstrated experimentally in animals following the induction of disseminated intravascular coagulation, but to our knowledge has not been previously described in humans.

Topics: Colloids; Disseminated Intravascular Coagulation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kidney; Liver Neoplasms; Lung; Neuroblastoma; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

In 3,600 patients evaluated with technetium-99m sulfur colloid for metastatic liver disease, 40 had equivocal scans due to a solitary defect in the interior margin of the right lobe. In these patients, the authors differentiated the gallbladder fossa from a metastatic focus using one of two new hepatobiliary agents: technetium-99m labeled pyridoxylideneglutamate and paraisopropylacetanilido iminodiacetic acid. In 31 patients, the focal defect filled with radioactive bile, showing that the solitary defect in the radiocolloid scan was a prominent gallbladder fossa. On laparoscopic biopsy, eight of nine patients whose focal defects were not due to the gallbladder were found to have metastatic disease. The ninth patient had carcinoma of the gallbladder. The need for laparoscopic biopsy was obviated in a majority (78%) of the patients by identifying the gallbladder fossa.

Topics: Adult; Aged; Colloids; Diagnosis, Differential; False Positive Reactions; Gallbladder; Gallbladder Neoplasms; Humans; Liver; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid