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

The coupling of hematologic data with radionuclide studies of the spleen has provided information as to the functioning of the organ in a variety of disease states. The major radionuclide studies have been presented in terms of the type of information derivable and the various conditions that can result in fairly similar image presentations. By utilizing the imaging results in conjunction with other available data, a more coherent view emerges of the role of the spleen.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Gallium Radioisotopes; Humans; Indium Radioisotopes; Iron Radioisotopes; Male; Middle Aged; Radioactive Tracers; Radiography; Radioisotopes; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

While 99mTc sulfur colloid imaging, because of its availability and convenience, remains the initial procedure of choice for spleen imaging, selective spleen scanning with damaged 99mTc-labeled RBCs can provide additional information in some cases. These cases include overlapping left hepatic lobe and suspected splenic pathology but with poor radiocolloid uptake that precludes visualization. Other indications are detection of residual splenic tissue after splenectomy, suspected asplenia, polysplenia, and situs ambiguus. The selective 99mTc-denatured RBC scan is most useful to confirm or exclude defects seen on the radiocolloid study and to detect small amounts of splenic tissue.

Topics: Adult; Child; Erythrocytes; Female; Hematoma; Humans; Hypersplenism; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenectomy; Splenic Diseases; Technetium; Technetium Tc 99m Sulfur Colloid

Despite the fact that the spleen has multiple functions, only one has been widely used for evaluation of the organ by imaging techniques (phagocytosis of 99mTc sulfur colloid). The usual splenic uptake of this radiocolloid can by used to determine the size, location, and integrity of the organ. A major use of splenic radiocolloid imaging has been in the study of congenital defects. Thus, eventration of the diaphragm, accessory spleens, splenogonadal fusion, the asplenia and polysplenia syndromes, and the wandering spleen are amenable to study by means of intravenously administered radiocolloid. Interference with the splenic uptake of radiocolloid can be either focal or generalized (as in functional asplenia). Imaging of the spleen has a major role in evaluating suspected trauma of the organ and in following its clinical course. The return of splenic function after splenectomy (splenosis or accessory spleens) can be documented by radionuclide imaging, and likely by hematologic techniques when the volume of tissue is sufficiently large. The detection of intrasplenic lesions is important in tumor staging and as an alerting sign to an ongoing process.

Topics: Abscess; Adult; Child; Child, Preschool; Cysts; Diaphragmatic Eventration; Humans; Hypersplenism; Phagocytosis; Postoperative Complications; Radiation Dosage; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Neoplasms; Splenic Rupture; Splenomegaly; Technetium Tc 99m Sulfur Colloid

Sclerosing angiomatoid nodular transformation (SANT) is a benign, proliferative vascular lesion affecting the spleen. Few reports detailing the cross sectional and PET appearance of this lesion are available, and the lesion's behavior with ⁹⁹(m)Tc-sulfur colloid scintigraphy is previously unreported. Sclerosing nodular transformation of the spleen shows increased tracer accumulation on positron emission tomography, and a central scar-like appearance with an enhancing capsule and radiating septae on CT and MR studies that reflects the gross and histopathological features of the lesion may be visible. An understanding of this pathological finding may allow prospective recognition of the sclerosing nodular transformation of the spleen on cross sectional imaging studies.

Topics: Aged, 80 and over; Angiomatosis; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Positron-Emission Tomography; Radiopharmaceuticals; Sclerosis; Splenectomy; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The localization of intraabdominal abscesses is a difficult imaging problem in nuclear medicine, especially when the location of the abscess is in the area of the liver and spleen. The need for performing Tc-99m sulfur colloid liver-spleen scans before injecting indium-111 leukocytes for improved lesion detection and characterization versus performing In-111 leukocyte scans alone has been questioned in the literature. We present 3 patients with intraabdominal abscesses in the liver-spleen area, in which liver-spleen scans were performed before In-111 leukocyte scans. The findings of all were correlated with computed tomography and interventional procedures.. In all patients, the Tc-99m liver-spleen scan helped for accurate recognition of the location of the abscess, correlated with computed tomography findings, and were helpful for intervention and exclusion of the other sources of infection.. Data from these 3 patients reinforces the need for Tc-99m sulfur colloid liver-spleen scans before performing In-111 WBC scans for better localization and interventional treatment of intraabdominal abscesses.

Topics: Abdominal Abscess; Aged; Female; Humans; Image Enhancement; Indium Radioisotopes; Leukocytes; Liver; Liver Abscess; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spleen; Splenic Diseases; Subtraction Technique; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Diagnosis, Differential; Female; Hematopoiesis, Extramedullary; Humans; Liver; Lymphoma; Radiopharmaceuticals; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Adult; Ehlers-Danlos Syndrome; Hernia, Diaphragmatic; Humans; Indium Radioisotopes; Male; Radionuclide Imaging; Radiopharmaceuticals; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Abscess; Adolescent; Citrates; Citric Acid; Fusobacterium Infections; Gallium Radioisotopes; Hematoma; Humans; Laparotomy; Male; Radionuclide Imaging; Splenic Diseases; Subtraction Technique; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

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

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

The splenic uptake rate of Tc-sulphur colloid or Tc-tin colloid was measured and found to correlate well with splenic function. The normal tracer uptake rate was 0.0002/s-0.0006/s (measured uptake rate divided by measured injected activity). Lower values indicated hyposplenism (sensitivity = 0.97, specificity = 0.95), and values over 0.0006/s indicated hypersplenism (sensitivity = 0.96, specificity = 0.97). Higher values of splenic uptake were associated with proportional reductions in the white blood cell and platelet counts, and to a lesser extent the haemoglobin concentration in peripheral blood. Patients with rheumatoid arthritis had increased tracer uptake, but still below the criteria for hypersplenism, whereas patients with Felty's syndrome had tracer uptake rates in the 'hypersplenic' range.

Topics: Humans; Hypersplenism; Radionuclide Imaging; Sensitivity and Specificity; Splenic Diseases; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds

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

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

Liver-spleen scintigrams were performed in 42 patients with chronic hepatosplenic schistosomiasis. The scan patterns found are described and classified in five stages of increasing hepatic involvement. The scintigraphic classification correlates well with clinical parameters of disease severity. With higher stages, the number of symptoms and the severity of complications increase. The liver-spleen scan provides a simple and accurate means to determine extent of hepatic involvement and probabilities of complications in this disease.

Topics: Chronic Disease; Humans; Liver; Liver Diseases, Parasitic; Prognosis; Radionuclide Imaging; Schistosomiasis mansoni; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

A patient with fungal splenic abscesses is presented in whom multiple noninvasive diagnostic imaging modalities were available for correlation. Of the five imaging modalities, three (Gallium-67, ultrasound and computed tomography) were diagnostically useful, while two (liver-spleen scan and In-111 white blood cell scan) were not as useful. This case also stresses the use of repeated studies correlating with clinical impressions to obtain an accurate diagnosis in a potentially life-threatening condition such as splenic abscess.

Topics: Abscess; Adolescent; Candidiasis; Gallium Radioisotopes; Humans; Immune Tolerance; Indium; Leukemia, Monocytic, Acute; Liver; Male; Radioisotopes; Radionuclide Imaging; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Splenic pseudocysts have traditionally required splenectomy because of the risks imposed by partial splenectomy or excision of the cyst lining. During the past 2 years, a 6-year-old boy and a 9-year-old girl presenting with vague upper abdominal discomfort, palpable splenomegaly, and a large unilocular sonolucent cyst within the spleen, were treated by partial splenic decapsulation with preservation of the hilar blood supply. This procedure involves mobilizing the spleen by dividing the renal, colic, and diaphragmatic attachments; decompressing the liquefied cyst contents through a thoracostomy trochar; excising the outer splenic capsule and gaining hemostasis of the splenic wall with a running interlocked silk suture; and providing external tube drainage of the left upper quadrant. During the follow-up period of 26 and 12 months, splenic size has returned to normal. Serial nuclear scan and ultrasound show a small residual crescent-shaped deformity of the functioning splenic remnant. We conclude that partial splenic decapsulation for splenic pseudocyst is simpler and safer than other preservation procedures attempted, and carries no increased risk of recurrence from leaving a portion of the pseudocyst wall.

Topics: Child; Cysts; Female; Humans; Male; Methods; Radionuclide Imaging; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

A case of a 23-year-old man with an encapsulated, anaerobic splenic abscess is reported. Both the In-111 leukocyte and Tc-99m sulfur colloid scans demonstrated an intrasplenic defect. The Ga-67 citrate scan revealed uptake in the rim of the abscess only where the abscess cavity was relatively photon-deficient. The combined Tc-99m sulfur colloid/In-111 leukocyte/Ga-67 scan appearance of a subacute splenic abscess has not been described previously. In cases suspected to be splenic abscesses the combined In-111 leukocyte/Tc-99m sulfur colloid imaging is the most useful.

Topics: Abscess; Adult; Gallium Radioisotopes; Humans; Indium; Leukocytes; Male; Radioisotopes; Radionuclide Imaging; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

By splenic imaging, a large focal defect was demonstrated in a symptomatic South American immigrant with simultaneous parasitic infestation of strongyloidiasis and entamebiasis. The CT scan also was thought to be abnormal. Pathologic findings reported a variation in splenic configuration. Unusual splenic configuration should be considered in the differential diagnosis of abnormal scans.

Topics: Adult; Diagnosis, Differential; Humans; Male; Radionuclide Imaging; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

Dual radionuclide subtraction imaging of the spleen using 67Ga citrate and 99mTc is useful in further delineating lesions that are identified on either a routine radiogallium survey or on a conventional sulfur colloid liver-spleen image. Better anatomic localization of left subphrenic abscesses may be obtained. Differentiation of tumors and abscesses from less serious lesions such as cysts, infarcts, and hematomas is possible. We have found this technique to be generally applicable to any organ that can be selectively imaged using a technetium radiopharmaceutical, including the liver, bones, and kidneys. In addition, we are currently evaluating thallium-pertechnetate subtraction imaging in the evaluation of parathyroid adenomata.

Topics: Aged; Embolism; Gallium Radioisotopes; Humans; Male; Methods; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Subphrenic Abscess; Subtraction Technique; Technetium Tc 99m Sulfur Colloid

The spleen is free to move around on its pedicle, since it is not fixed in the abdomen. We describe the case of a woman who demonstrated a temporary rotation of the spleen 90 degrees from its usual axis as shown by liver-spleen scintigraphy using technetium Tc-99m sulfur colloid (99mTc SCOL). The reason for this rotation is discussed. Other previously reported causes of splenic displacement are also reviewed.

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

A 47-yr-old man with malignant mastocytosis, a malignant neoplasia of mast cells, presented with anemia. Ultrasonography revealed an enlarged spleen. A liver-spleen scan using [99mTc]sulfur colloid failed to show any splenic uptake consistent with the diagnosis of functional asplenia. Functional asplenia related to this condition has not been reported previously. Since the spleen was heavily infiltrated with space occupying mast cells, a mass displacing effect along with impaired perfusion are discussed as underlying mechanism.

Topics: False Negative Reactions; Humans; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenectomy; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Urticaria Pigmentosa

Topics: Follow-Up Studies; Humans; Infant; Male; Radionuclide Imaging; Radiotherapy; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Time Factors

An intrasplenic pancreatic pseudocyst may mimic a subcapsular splenic hematoma. Misdiagnosis of this entity may have serious consequences. Particular care should be taken when a patient presents with a cystic mass in the region of the spleen and a history of chronic alcohol abuse, regardless of the presence or absence of a history of a traumatic episode. Thin-needle aspiration is the current diagnostic modality of choice. A high fluid amylase level establishes the diagnosis of an intrasplenic pancreatic pseudocyst.

Topics: Adult; Amylases; Colloids; Diagnosis, Differential; Drainage; Hematoma; Humans; Inhalation; Male; Pancreatic Cyst; Pancreatic Juice; Pancreatic Pseudocyst; Radionuclide Imaging; Spleen; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A case of wandering spleen with torsion of the splenic vascular pedicle and pancreatic tail is presented. The entity was diagnosed and evaluated preoperatively with various imaging modalities (ultrasound, nuclear medicine, and CT) as well as visceral angiography.

Topics: Adult; Angiography; Female; Humans; Radionuclide Imaging; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography

Topics: Erythrocyte Inclusions; Humans; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid

Liver/spleen images were performed with technetium-99m sulfur colloid in 53 patients who had undergone bone-marrow transplantation. The spleen was not seen in the images in five out of the ten patients with chronic graft-versus-host disease (GVHD). None of the five had a history of splenectomy. In two of these patients, anatomical presence of the spleen had been documented earlier by scintigram. The spleen was visible in all seven patients with acute and in all 36 patients without GVHD. Neither the differences in methods of treating the patients before bone-marrow transplantation nor the time lapse between transplantation and the liver/spleen image correlated with the observed effect among these three groups of transplant patients. We conclude that there is a high association between chronic GVHD and functional asplenia.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Chronic Disease; Female; Gallium Radioisotopes; Graft vs Host Disease; Humans; Liver; Male; Radionuclide Imaging; Retrospective Studies; Spleen; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors; Whole-Body Irradiation

A case is discussed of a man who presented with trauma to the chest and abdomen. A radiocolloid image showed uptake by the liver. However, the spleen was not identified. Areas of activity outside of the spleen were noted. The patient had splenic avulsion; extra sites of activity likely represented bleeding sites in the abdomen. Failure to identify the spleen on a radiocolloid image, after trauma, should be an alerting sign to possible splenic avulsion (especially when there are also ectopic sites of accumulation of the radiocolloid).

Topics: Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Four children with acute leukemia and surgically documented candidiasis of the liver and/or spleen were examined with a combination of diagnostic imaging modalities including 99mTc-sulfur colloid and 67Ga-citrate scintigraphy, gray-scale ultrasound, and body computed tomography (CT). Abnormalities were detected in every individual examined. 99mTc-sulfur colloid scintigraphy revealed "cold" areas in the liver or spleen. With 67Ga scintigraphy, these areas were "cold" in some individuals and "hot" in others. Gray-scale ultrasound demonstrated hypoechoic lesions with central areas of increased echogenicity in hepatic involvement, and hypoechoic replacement of the spleen in splenic involvement. CT in one patient revealed low-density areas without contrast enhancement within the hepatic parenchyma and unsuspected renal involvement.

Topics: Adolescent; Candidiasis; Child, Preschool; Female; Gallium Radioisotopes; Humans; Infant; Leukemia; Liver Abscess; Male; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

A 43-year-old man with acute undifferentiated leukemia developed high fever and stomatitis followed by severe abdominal pain after completion of a first course of chemotherapy. A 99mTc-sulfur colloid (SC) scan showed multiple, irregular defects in an enlarged spleen. A 67Ga-citrate scan showed uniform tracer distribution except for a large defect in the upper portion of the spleen. The size of the spleen in the 67Ga-scan was much larger than in the SC scan. At surgery an abscess cavity was found between the spleen and the greater gastric curvature with multiple smaller abscesses on the splenic capsule and throughout the splenic parenchyma. A hematoma was present in the upper pole of the spleen. The disparate splenic size and seemingly discordant distribution patterns of tracer in the 99mTc- and 67Ga-scans were fully explained by histopathological study of the surgically resected spleen.

Topics: Abscess; Acute Disease; Adult; Aspergillosis; Gallium Radioisotopes; Humans; Leukemia; Male; Radionuclide Imaging; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Colloids; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Radionuclide Imaging; Spleen; Splenic Diseases; Sulfur; Syndrome; Technetium; Technetium Tc 99m Sulfur Colloid

Five cases are presented in which intrasplenic defects, noted on Tc-99m sulfur colloid imaging, had at least partially regressed on follow-up studies. One, representing splenic trauma, reinforced the concept of the ability of the spleen to "heal" itself. A second case involved splenic invasion by direct extension of a soft tissue sarcoma. Improvement was noted after the patient was treated with chemotherapy. Three cases were related to splenic manifestations of lymphoma. Of these three patients (one each with lymphocytic, histiocytic, and mixed diffuse histiocytic lymphoma plus nodular), two showed improvement after treatment with chemotherapy alone and the third after combined chemotherapy and external radiation treatment. Return of splenic reticuloendothelial function to previously involved regions within the spleen occurred for all five patients. Comments were made as to the apparent rate of return of function.

Topics: Aged; Child, Preschool; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Sarcoidosis involves the spleen in a significant percentage of patients afflicted with this disease. The most commonly applied modality for studying such patients is the (99m)Tc-sulfur colloid scan. Different patterns have been recognized: "normal" spleen and nonspecific splenic enlargement, with or without focal areas of photon deficiency, which was thought to represent an infarction in a previous report. We have encountered two patients showing splenomegaly and multifocal photon deficiencies secondary to sarcoid granulomata. These cases are presented to inform clinicians of a new pattern. Our patients were managed with systemic corticosteroids and palliation of pain. If symptoms persist or worsen, splenectomy may be necessary to avoid spontaneous rupture. An abbreviated differential diagnosis of the enlarged spleen with multiple focal defects is discussed.

Topics: Adult; Female; Humans; Radionuclide Imaging; Sarcoidosis; Splenic Diseases; Splenomegaly; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Diagnosis, Differential; Female; Hematoma; Humans; Middle Aged; Radionuclide Imaging; Splenic Artery; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Topics: Adolescent; Humans; Male; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Rupture; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

An additional case of wandering spleen is reported. A brief review of the etiology of this entity, as well as various findings obtained with nuclear imaging of the spleen, is presented. The authors discuss the relevance of repeated spleen scans to the clinical decision making process. Particular significance is paid to preservation of the spleen to maintain immunologic competence.

Topics: Child, Preschool; Decision Making; Female; Humans; Liver; Movement; Physical Exertion; Radionuclide Imaging; Spleen; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Abscess; Adult; Aeromonas; Antineoplastic Agents; Escherichia coli Infections; Female; Gallium Radioisotopes; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography